222381 07/30/2013 *f CITY OF CARMEL, INDIANA VENDOR: 367119 Page 1 of 1
ONE CIVIC SQUARE EVERGREEN MOUNTAIN, LLC
CARMEL, INDIANA 46032 PO BOX 1169 CHECK AMOUNT: $400.00
'o e� TAOS NM 87571-1169
CHECK NUMBER: 222381
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4357002 25371 125 400 . 00 TRAINING
EGA INVOICE
DATE: July 15, 2013
Evergreen Mountain, LLC
PO Box 1169
Taos NM,87571-1169 INVOICE# 125
Phone(910)635-2217
FOR: NIGHT VISION
BILL TO: COURSE
CARMEL POLICE DEPARTMENT
THREE CIVIC SQUARE
CARMEL INDIANA,46032
317-571-2500
FOR RYAN JELLISON
DESCRIPTION #of STUDENTS RATE per Student #DAYS of TRAINING AMOUNT
TWO DAY NIGHT VISION COURSE 1 $200 2 $ 400.00
COURSE. DATES OF TRAINING
30 SEPTEMBER- 1 OCTOBER,2013
SUBTOTAL $ 400.00
TAX RATE 0.00%
SALES TAX -
OTHER -
TOTAL $ 400.00
Make all checks payable to Evergreen Mountain,LLC
THANK YOU FOR YOUR BUSINESS!
C4 INDIANA RETAIL TAX EXEMPT PAGE
ily o Carmel CERTIFICATE NO.003120155 002 0 li PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT WI
35-60000972
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
30120"13
Evergreen Mountain LLC Camel Polico Department
VENDOR SHIP 3 CIVIC squam
TO
P.O. Box 196e Carrel, IN
Taos, NM 876794169 (3$7)571
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS - FREIGHT
I' QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account.00.670.00
1 Each training $400.00 $400°00
Scab Total: $.00.00
qP°.A
-4
3 �
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Send sl
Basle et Tosian Coarse for Sgt. RWin .Rallis e . 0 - �: 013 In East Chicago, IN
I
Carmal Police Department
Attn: Teresa Anldorson
3 CIVIC -SgUa e
Carmel, IN 46 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $460.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY T,AT THERE IS AN'UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT'TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. _
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE C i �g r ��ll�>�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
2-53 l� CLERK-TREASURER
DOCUMENT CONTROL NO. A.P. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
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))
07/15/13 125 night vision course $400.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Evergreen Mountain LLC
IN SUM OF $
P.O. Box 1169
Taos, NM 87571-1169
$400.00
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25371 125 -570.00 $400.00 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
r ( Wednesda , July 24, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund