221439 07/02/2013i
CITY OF CARMEL, INDIANA VENDOR: 357200 Page 1 of 1
` ONE CIVIC SQUARE CANNON IV, INC
_ CHECK AMOUNT: $94.59
CARMEL, INDIANA 46032 Po sox 697
INDIANAPOLIS IN 46206-0697 CHECK NUMBER: 221439
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4230200 26800 INV348638 94 . 59 INKJET BOND
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Invoice No: INV348638
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gSO Dorman Steet Indianapolis, IN46Z0Z-3544 Date: 6/I5/2013
P: 317-951-0500 F: 317'051'0600 Account No: 5712414-003
Bill To: City OfCarmel Ship To: City OfCarmel
Attn: ]anetArnone Attn: Dave McCoy
31 1st Ave N.W. Three Civic Square
Carmel, IN 46032 Carmel, IN 46032
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S0237271 ---'- Best wa'.; Net 30 Days -7/25/2013
Mark Benefiel
3092401-4 24x150 24#Premium Coated Ink3et 1.0 1.0 0.0 CTN/4 $83.69 $83.69
Bond
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PLEASE REMIT ALL PAYMENTS TO: Subtotal
CANNON IV,INC.
p.O. BOX 097 Discount
INDIANAPOLIS,zm*szoo'oo97 Freight
Sales Tax
Past due amounts are subject toa Finance Charge nf Invoice Total
1 1/2Y6 per month (1896APR). Balance Due [Eit
Page 1of1
u0 INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO.003120155 002 0 1i l�. V xo' 1i Carmel PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26900
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
6/1 612013
Cannon IV Carmel Communications
SHIP Terry Crockett
VENDOR 950 Dorman Street TO 3 Civic Square
Indianapolis, IN 416202-3544 Carmel, IN 46032
(317)571-2567
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 412-302.00
1 Each 3092401-4 24x150 24#Premium coated Inkjet Bond $83.69 $83.69
Sub Total: $83.69
a d
F\
i Send Invoice To:
City of Carmel
Terry Crockett
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
Carmel IS Dept. PAYMENT M.69
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. -
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE J�rIC�c. �G�iG• .
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. -
CLERK-TREASURER
DOCUMENT CONTROL NO. 2 6 8 Q®
A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF$
S
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))
06/25/13 I INV348638 I I $94.59
1 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
Cannon IV
IN SUM OF $
950 Dorman Street
Indianapolis, IN 46202-3544
$94.59
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26800 I INV348638 I 42-302.00 I $94.59 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
Thursday, June 27, 2013
i
/ Dir for , IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund