221088 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 362241 Page 1 of 1
ONE CIVIC SQUARE HORIBA INTERNATIONAL CORP
CARMEL, INDIANA 46032 LOCKBOX 776013 CHECK AMOUNT: $151.50
6013 SOLUTIONS CENTER
CHECK NUMBER: 221088
CHICAGO IL 60677-6000
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239099 25727 90445860 151 . 50 AERASOL SPRAY
HORI A INVOICE
Scien-tifi&.- "iso--9,001
HORIBA INSTRUMENTS INCORPORATED
3880 Park Ave -->REM/T TO: Lockbox # 776013
Edison, NJ USA 08820-3012 6013':Soluti6ns: Center:
Phone: (732) 494-8660, Fax: (732) 549-5125 Chicago,.:IL 60677-6000
www.HORIBA.com/Scientific
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Bill To: 29379 Invoice Number 90445860
Invoice Date 05/16/2013
Purchase Order No. 25727
CARMEL POLICE DEPARTMENT Purchase Order Date
ATTN: TERESA ANDERSON Sales Order Number 252437
3 CIVIC SQUARE
CARMEL IN 46032-2584 Packing List Number 80350415
Shipping Terms FOB ORIGIN
Actual Ship Date 05/16/2013
Payment Terms WITHIN 30 DAYS DUE NET
Due Date 06/15/2013
_..:: ........_::_..: ..._.. .......... —
Shi
P::Ta;.;;29379
CARMEL:, Currency USD
ATTN:.:JOH,WELLIOTT Bill of Lading
3 CIVIC>SQUARE';' Sales Office JY04
CARMEL IN' 46032-2584'
Invoice Details
Item Material Quantity Unit Price Amount
Description
10 CP78500 10 EA 15.95 159.50
NIN-PRINT 250ML SPRA
Customer Disc (Val) 2.00- 20.00-
Net Value for Item 13.95 139.50
Freight 12.00
-----------------------
Total Amount.... $ 151.50
WE_CERTIFY>;THAT THESE GOODS,WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF-._SEC.:6,:J:AND:iI OF THE FAIR LABOR'
STANDARDS ACT,AS AMENDED, AND OF REGULATIONS AND ORDERS OF THE U.S'r?DEPARTMENT-OF LABOR ISSUED UNDER SEC: 14 THEREOF,
INDIANA RETAIL TAX EXEMPT PAGE
City ® II Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 25'x`27
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
518120`13
SPEX Forensics Cannel Police Department
VENDORHORIl3A Instruments incorporated TOIP 3 Civic Square
3880 Pare Avenue Camel, IN 4
Edieon NJ 0020.3012 M71571-2559
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 420.99
10 each Nin-Print Aer%ol Spay CP78500 $13.95 $139.50
I Each shipping charges $12.00 $12.00
Sub Total: $151.50
Ca4.
tea•.
a � �e
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Send Invoice To: U V
Carmel Pollee Department
Attn: Tomsa Anderson
3 Civic Squares
Camel, IN 4m PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. `- PAYMENT $9x1,50
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT/THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRI TIO (SUFFICIENT TO PAIF FOR-THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY i`• / �r�
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. F .� t�
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 'hla#�of Police)
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 4 IA .7. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# 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____�.______ _�__._____
20 !
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
05/16/13 90445860 lab supplies $151.50
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
SPEX Forensics
HORIBA Instruments Incorporated IN SUM OF $
Lockbox#776013 6013 Solutions Center
Chicago, IL 60677-6000
$151.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25727 I 90445860 I 42-390.99 I $151.50 1 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
Friday, June 14, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund