221985 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 362355 Page 1 of 1
0 ONE CIVIC SQUARE G H S CHECK AMOUNT: $2,943.00
�• to CARMEL, INDIANA 46032 8349 N WASHINGTON STREET
o� SHERIDAN IN 46069 CHECK NUMBER: 221985
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 25748 2013-1561 2 , 943 . 00 CONVERT 2X4 LIGHT FIX
GIBS, Inc.
Sheridan, IN 46069
Women-Owned Business Enterprise
Bill To Invoice
City of Carmel Police Department
Attn: Teresa Anderson Date Invoice#
3 Civic Square
Carmel,IN 46032
7/8/2013 2013-1561
P.O. No. Due Date Terms
8/7/2013 Net 30
Quantity Descriotion Price Each Amount
1 Convert 18 2x4 fixtures to LED;rewire,remove ballasts and install 2,943.00 2,943.00
2 4'LED lamps per fixture
Thank you for the opportunity to bid on this project Total $2,943.00
Payments/Credits $0.00
A 1.5%Service Charge will be assessed on amounts over 30 days past due. Balance Due
$2,943.00
0 f� Carmel . INDIANA RETAIL TAX EXEMPT PAGE
C ® 11 . CERTIFICATE NO.003120155 002 0�/ � 11 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 'A7AA
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, 1P'
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
OJ1MI693
OHO, Inc. Camel Pollee Dopartmont
VENDOR SHIP
TO 3 Civic squam
8349 North Washington Street Camel, IN
Sheridan. IN 46113 17157 1-
CONFIRMATION BLANKET rOF::M:E=ASURE AS PAYMENT TERMS FREIGHT
QUANTITY UNIT DESCRIPTION UNIT PRICE EXTENSION
.i
A6count 43.601.00 !<.
48 Each convert 2x4 light fixtures to'LED lamps $163.50 $2,043.00
Sub Total: $2,043.00
�•~ z'' :r t *mss` `
'.y.... � yam'',:a. 4 ,e0.,. �; ✓ as �,, `'�},,
Send Invoice To: �13 % b
Carmel Pollen Department
Attu: Teresa Andsmon
3 Civic Square
Camel, IN 46=- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ,ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Entice Dept. ` . ) PAYMENT22, 3,
{ A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• /
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /•%•}'f f3�.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. f{j/
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE /+�i a-8 police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ®•v
2 5 ! t CLERK-TREASURER
DOCUMENT CONTROL NO. A•P • COPY-SIGN AND RETU,R'N TO CLERK'S OFFICE
VOUCHER NO. � WARRANT
ALLOWED 20
IN THE SUM OF$
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# 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
20
.............................................................................. . .......................................................-- . ----- .....
Signature
--.............._........._... ..................................... .......................
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
GHS, Inc.
IN SUM OF $
8349 North Washington Street
Sheridan, IN 46069
$2,943.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25748 I 2013-1561 I 43-501.00 I $2,943.00 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
Wednesday, July 10, 2013
Chief of Police
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))
07/08/13 2013-1561 convert light fixtures $2,943.00
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