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224238 09/23/2013 CITY OF CARMEL, INDIANA VENDOR: 367001 Page 1 of 1 t, ONE CIVIC SQUARE CAPITAL ONE COMMERCIAL CHECK AMOUNT: $528.16 ,a CARMEL, INDIANA 46032 PO BOX 5219 CAROL STREAM IL 60197-5219 CHECK NUMBER: 224238 CHECK DATE: 9/2312013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4239039 479 . 22 7003731100072984 1082 4239039 48 . 94 7003731100072984 Please Direct Inquiries To:1-800-220-8594 COSTC0. COSTCO WNOLESiAIE Account Number New Balance Payment Due. Amount Past;4ue Due.Date 7003 7311 0007=2984 $528 16 $00 $QO Billin Date. Credo Line;' affable Credit g; 08/26%2013 $.5,000 P1471 84 TDD/Hearing Impaired: 1-800-365-0186 STATEMENT OF YOUR ACCOUNT 0 o FII.ANC CHARGE SI MJM1ARY.. ° ° Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo o Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire Description Number Balance Rate APR Periodic Rate RATE Due Reg 00014 $34.07 0.00000% 00.00% $.00 00.00% $528.16 $.00 09/26/2013 0 0 0 ACCOUNT DETAIL ° Transaction TransaCt[On M4oice.. user IaQ Transactlpil .. ° Date Descripttol . Number ID Number Am tit .. . , 08/12/2013 COSTCO WHOLESALE-347 054954 00005 $420.74 00005 SUBTOTAL: $420.74 08/15/2013 COSTCO WHOLESALE-346 013128 00006 5707.42 00006 SUBTOTAL: $107.42 08/16/2013 PAYMENT-THANK YOU 00001 $294.30- Your account information is in your control when you register securely at www.hrscommercial.com RE� .7g Tom+ D SEP 05 2013 �Y. Return the below portion with payment.For billing errors or questions please refer to the back of the statement. Page 1 of 2 Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement will be presumed to be correct. Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160. You may telephone Capital One Commercial at 1-800-210-8115,but it will not preserve your rights. Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user. COS COSTCO 05"E ACCOUNT ACCOUNT SUMMARY BALANCE SUMMARY .... .. Outstanding CURRENT ,. 129 DAYS PAST©UE. 30 59 DAYS PAST DUE Transaction $294.30 +New $.00 $.00 $.00 Purchase(s)/Debit(s) $528.16 +New Fees $.00 60-89 DAYS RAST DEJE 90 119.DAYS PAST DUB 120 a.49 CLAYS PAST .....__. ......... ...... _.......... ........ ... ........_.. ........._...... _. ..........._... +Finance Charges $.00 $.00 $.00 $.00 Payment(s) $294.30 150 Y79 DAYS PAST DUB ..................DAYSPAST CLUE ' Credit(s) $.00 0 o $.00 $.00 =New Balance $528.16 `o N O O O V a 0 0 0 0 0 0 0 0 v 0 0 n Page 2 of 2 Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement will be presumed to be correct. Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160. You may telephone Capital One Commercial at 1-800-210-8115,but it will not preserve your rights. Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user. 22CAP720298(02/13) - TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS AND NUMBERS ONLY! C a❑❑❑❑❑❑❑❑❑❑ ❑❑❑❑❑❑❑❑❑❑❑❑❑❑ Email Address ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ Street Number if an Street Name or the words TO BOX" Unit or PO BOX Number ❑❑ ❑❑❑❑❑❑❑❑❑❑❑ ❑❑[:I❑❑ C t F_]❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ State ZLJLJ❑❑❑ Business Phone ❑❑❑/❑❑❑�❑❑❑ ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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 (Costco) Purchase Order No. 367001 Capital One Commercial Terms P.O. Box 5219 Date Due Carol Stream, IL 60197-5219 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 8/26/13 7003731100072984 General program supplies $ 229.49 8126!13 -7003731.100072984 General program supplies $ 142.31 8/26113 7003731100072984 General program supplies $ 107.42 8/26/13 7003731100072984 General program supplies $ 48.94 Total $ 528.16 1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance with 1C 5-11-10-1.6 20_ Clerk-Treasurer Voucher No. Warrant No. (Costco) 367001 Capital One Commercial Allowed 20 P.O. Box 5219 Carol Stream, IL 60197-5219 In Sum of$ $ 528.16 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or Board Members INVOICE NO. ACCT#/TITLE AMOUNT Dept# 1081-3 7003731100072984 4239039 $ 229.49 1 hereby certify that the attached invoice(s), or 1081-9 7003731100072984 4239039 $ 142.31 bill(s) is (are)true and correct and that the 1081-11 7003731100072984 4239039 $ 107.42 materials or services itemized thereon for 1082-13 7003731100072984 4239039 $ 48.94 which charge is made were ordered and received except 19-Sep 2013 Signature $ 528.16 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund