221085 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 129000 Page 1 of 1
ONE CIVIC SQUARE HOLDER MATTRESS CO, INC
CARMEL, INDIANA 46032 130 W MORGAN STREET CHECK AMOUNT: $1,745.44
' ? KOKOMOIN 46901
CHECK NUMBER: 221085
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463000 060113CFD4 1, 745 . 44 FURNITURE & FIXTURES
Holder Mattress Factory
Built for Comfort — Designed to Last
Since 1947
Inv®ice
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
Invoice Number: 060113cfd4
Invoice Date: 6/1/13
Invoice Due Date: 7/1/13
Customer Approval: James Spelbring
Item• Description: Quantity Item Price Total Price
#1 Keystone XL Twin 4 $436.36 $1,745.44
Station #41
Invoice Sub-Total $1,745.44
IN Sales Tax 7% EXEMPT
Total Invoice Due $1,745.44
I
• Payment terms Net 10 from date of delivery
• Proof of Deliveries, Signed Quote Approval Attached
Deliveries to the Following:
4 Sets to Station 41 at 2 Civic Square
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236-1492; Fax (765) 236-1495
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I
I
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
060113cfd4 I I $1,745.44
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Holder Mattress
IN SUM OF $
130 West Morgan Street
Kokomo, IN 46901
$1,745.44
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 I 060113cfd4 1 102-630.00 I $1,745.44 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
II IA 7 2013
i
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund