226289 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 365197 Page 1 of 1
ONE CIVIC SQUARE EMP TECHNICAL GROUP INC
! CHECK AMOUNT: $1,045.00
�ro CARMEL, INDIANA 46032 15309 STONY CREEK WAY
NOBLESVILLE IN 46060 CHECK NUMBER: 226289
CHECK DATE: 11/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4230200 25453 19878 1, 045 . 00 PERFORATED ROLLS
Invoice
REMIT TO:
15309 Stony Creek Way
Noblesville, IN 46060 Date Invoice#
317-776-6700
11/8/2013 19878
TECHNICAL
GROUP
Bill To Ship To
Carmel Police Department Carmel Police Department
3 Civic Square 3 Civic Square
Carmel,IN 46032 Carmel, IN 46032
ATTN:Teresa Anderson Attn: PO#: 25453
P.O. Number Terms Ship Via UPS# FedEx# F.O.B.
25453 Net 30 11/6/2013 Best Way N/A N/A Factory
Quantity Item Code Description U/M Price Each Class Amount
20 LB3663-CASE Perforated roll,6 roll pack, 100 sheets per ea 49.75 15769 995.00T
roll,priced per case.
Shipping Shipping/Handling 50.00 15769 50.00T
Thank you!
Total $1.045.00
Phone# Fax#
317-776-6700 317-219-0535
INDIANA RETAIL TAX EXEMPT PAGE
City of Ca- rmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 25453
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
10 =13
Entmpri a Technical Group Carmel Police 9Gpa want
VENDORBen SHIP 3 CIVIC squwa
TO
155309 Stony Creek Way Can-nel, IN 4M
Noblesville, IN 46W0 (317)679 M
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-S 2.00
20 Each Perforated roll LE3663 $49.75 $995.00
1 Each stripping charges $58.00 $56.00
Saab Total: $1,053.00
ell
Send Invoice To:
Carmel Police Department
Attn: ` omsa Anderson
3 Citric Square
Carmel, IN - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
.armel Police Dept. �-� PAYMENT $1,053.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY �" ✓ ° /�
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.. /
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE I Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
J 4 J CLERK-TREASURER
,DOCUMENT CONTROL NO. A.P. . COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.' WARRANT NO.
ALLOWED 20
IN THE SUM OF$
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
._._------------
i
Signature
_-- -- �_-- Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts Ci ty 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))
11/08/13 19878 perforated rolls $1,045.00
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO:
EMP ALLOWED 20
I IN SUM OF°$:t;s
15309 Stony Creek Way
Noblesville, IN 46060
$1,045.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25453 I 19878 I 42-302.00 I $1,045.00 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
Thursday, November 14, 2013
�Alyls\ Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund