221567 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 365862 Page 1 of 1
ONE CIVIC SQUARE INDIANA FEDERAL SURPLUS PROPERTy
CARMEL, INDIANA 46032 ATTN ANGIE WHEELER CHECK AMOUNT: $200.00
o� 601 W MCCARTY ST SUITE 100 CHECK NUMBER: 221567
INDIANAPOLIS IN 46225
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 R0029 200 . 00 OTHER EXPENSES
State of Indiana Return Payment/Correspondence to:
Federal Surplus Property Angie Wheeler,Account Clerk
601 W. McCarty St.Ste.100 Phone:317-234-3687 Fax:317-234-3699
Indianapolis, IN. 46225
"......... ...._....
.. �,.
X616
Date: 06/19/13
Carmel Utilities
Attn: JOHN DUFFY, UTILITY DIRECTOR
760 THIRD AVENUE SW
CARMEL IN 46032
1DUFFY @CARMEL.IN.GOV
Card: 1616 Date DD#/Invoice# Amount Due
6/19/2013 860.1 J $ 200.00
Total Amount Due Upon Receipt of This Notice:
:Please;sign;and,date the WHITE copy',of,the,attached Distribution Documents :and RETURN the;WHITE.
copy)of eacha with;the:origi "I in signature,to our office Complete and return any"other documents [
attached - ; ,.
Pleaselremit,FULL:Paynient for.the attached Distribution Documents(s)aPayment:must be:in the form',
X., .....;, , ,
of a check drawn from your ORGANIZATION/AGENCY accountT
Past Due Notice
30 Days Past-Due 60 Days Past-Due
Payment for the attached Distribution Document(s) is past-due. Please remit full payment to avoid
penalties indicated below.
Return of Property.
This account is seriously past-due (90 days).
To avoid deferment, remit full payment or return the property by
Temporary Deferment
A letter of Deferment is enclosed because of your seriously past-due account.
I
a�szrra
eyf ' DISTRIBUTION DOCUMENT AND INVOICE DDI Numbers
State Form 9738(R4/3-13)
Approved by State Board of Accounts,2013 / r
end
INSTRUCTIONS: Payment must be in the form of a check drawn from the official account of the donee listed below. Mail your remittance with a copy
of this invoice to: Indiana Federal Surplus Property, 601 W.McCarty Street,Suite 100,Indianapolis,IN 46225.
For assistance,please call 317-234-3685.
THIS INVOICE SHALL BE ATTACHED TO THE REGULAR CLAIM FORM FOR ALL POLITICAL SUBDIVISIONS(36-1-2-13).
Card Number Donee Type: Distribution Date(month,day,year)
Charge to(Donee) e'q e11�,L UT/r-/'T/ S Agency Clerk
`766, -FIVIRL) AVE- Sw A.►�a.�/A
Direct Pick Up Warehouse Pick Up
Cardholder County Restrictio Period:
TaNA.) l7 v 1=F y o29 iyla s .
RESTRICTION Property with A/C under Property with A/C$5,000.00 or Non-combat aircraft and Combat-Type Property is under
NOTES_ $5,000.00 is restricted for more,and property that requires carriers are restricted for Perpetual restriction and remains the
one(1)year. a title/registration are restricted five(5)years. property of the federal government.
for eighteen(18)months.
NOTE TO DONEE-USE OF PROPERTY REQUIREMENTS:The property listed below is federal property and will remain federal property until all
requirements listed on the reverse side have been met by the donee and ownership is released by INSASP and/or GSA.
NOTE TO AGENCY CLERK-Indicate the VIN for vehicles and Serial Numbers for all property with an original acquisition cost of$5,000.00 or more.
123 Number A/C Unit Cost A/C Extension Property Description Qty HIC Unit Cost H/C Extension
4B 9. p89. —�' a RKLI Fi / a o o . o . °a
a
IT_0 --A U C,-c-T�
Total Original $ Do Total Handling
Acquisition Cost �� yO /•— Charge D o,
I certify the materials and services shown above were furnished by INSASP;that the items of this claim are just and legal;and that there is due INSASP
the amount shown above in the total handling charge column.
Signature of INSASP Representative
I am authorized by the donee to remove the property listed above and deliver it to the donee. A letter of authorization must be attached.
Signature of Transporter Printed Name Date(month,day,year)
Being the duly authorized representative of the above donee,I accept the property listed above and commit the donee to comply with the terms,
conditions and certifications printed on the reverse side of this document. In addition,I certify that the above donee is not presently debarred,
suspended,proposed for debarment,declared ineligible,or voluntarily excluded from participation in this transaction by any Federal department or
agency,as defined in 41 FR 105-68.
Signatur of Donee epr ntative Pry tamed Name/ / Date(month,day,year)IL
DIS,%IBUTION WhNe-InvoiceF,Canary-Donee File;Pink-Posting File;Goldenrod-Donee Copy
u
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
T0677
STATE OF INDIANA FEDERAL SURPLUS Purchase Order No.
601 W MCCARTY ST STE 100 Terms
ATTN: ANGIE WHEELER, ACCOUNT CLERK Due Date 7/1/2013
INDIANAPOLIS, IN 46225
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/1/2013 R0029 $200.00
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
Date 'Off(Ur
VOUCHER # 135905 WARRANT # ALLOWED
T0677 IN SUM OF $
INDIANA FEDERAL SURPLI
601 W MCCARTY ST STE 100
ATTN: ANGIE WHEELER, ACCOUNT C
INDIANAPOLIS, IN 46225
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
R0029 01-7750-08 $200.00
Voucher Total $200.00
Cost distribution ledger classification if
claim paid under vehicle highway fund