224396 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 367268 Page 1 of 1
ONE CIVIC SQUARE ADAMS INDUSTRIES INC
CARMEL, INDIANA 46032 PO BOX 641413 CHECK AMOUNT: $1,290.00
•, ,o�`o, LOS ANGELES CA 90064 CHECK NUMBER: 224396
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4239010 25554 202201 1, 290 . 00 MOUNT SYSTEM/ASSEMBLY
Invoice
P.O. Box 641413
Los Angeles, CA 90064 DATE INVOICE#
J
(310) 472-31017 (3310) 861-5324 Fax
ffi X , d
9/13/2013 202201
-Z ErN/TIN: 95-4547850; CAGE: I SMP2
us
BILL TO SHIP TO
CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
ATTN:TERESA ANDERSON ATTN: SGT. RYAN JELLISON
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL,IN 46032 CARMEL, IN 46032
Email:rjellison@carmel.in.gov Email: rjellison@carinel.iii.gov
P.O. NUMBER TERMS DUE DATE REP SHIP VIA F.O.B.
35353 Net 30 10/13/2013 CBA 9/13/2013 UPS DELIVERED
QUANTITY ITEM CODE DESCRIPTION PRICE EACH AMOUNT
6 A3256347 A3256347: Headset Adapter(PVS-14 J-Arm),NSN 85.00 5 1 O.00T
5965-01-444-1216.
4 A3256368-2 A3256368-2: NIGHT VISION 14ELMET MOUNT ASSY, 195.00 780.00T
ACH/MICH.
Subtotal $1.290.00
Export of the items described herein may require an export license issued by the U.S.
Department of Commerce,Bureau of Industry and Security,or the U.S.Department of Sales Tax (0.0%) $0.00
State,Office of Defense Trade Controls. It is the responsibility of the purchaser to comply
with all appropriate U.S. Laws. Total $1,290.00
Past Due Accounts that go over their terms will be charged a 1.5%finance charge per
month they ace oNtiht Payments/Credits $0.00
Please iii.,k-eyour check payable to Adams Industries.. Inc. and mail it to P.O. Box 641413;
Los Angeles,CA 90064. Balance Due $1:290.00
Wiring Information: City National Bank;2029 Century Park East Suite 100;Los Angeles,
CA 90067;+1-310-282-7808 phone;ABA/Routing Number: 122016066 SWIFT Code
(International): CFNAUS6L-,Account name:Adams Industries,Inc.;Account Number:
001-301-519.
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))
09/13/13 202201 night vision accessories $1,290.00
i
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
IN SUM OF $
0". 6q,,< Lo q I q L3
$1,290.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25554 Encumbered I hereby certify that the attached invoice(s), or
202201 I 42-390.10 I $1,290.00
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, September 19, 2013
r
g� Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund