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Home My WebLink About226467 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 357097 Page 1 of 1 ONE CIVIC SQUARE SERVICE FIRST CLEANING,INC CHECK AMOUNT: $4,838.20 CARMEL, INDIANA 46032 PAYMENT PROCESSING CENTER 32145 BROOKSTONE DRIVE CHECK NUMBER: 226467 WESLEY CHAPEL FL 33545-1656 CHECK DATE: 11/19/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1801 4350600 27132 153240 311 . 00 CLEANING 651 5023990 153303 320 . 00 OTHER EXPENSES 1115 4350600 153307 500 . 00 CLEANING SERVICES 1202 4350600 153308 300 . 00 CLEANING SERVICES 1110 4350600 153309 2 , 225 . 00 CLEANING SERVICES 2201 4350600 153310 982 . 20 CLEANING SERVICES 1701 4350600 153312 200 . 00 CLEANING SERVICES Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice ` Payment Processing Center Order No: Y 9 153310 SERVICE FIRST 32145 Brookstone Drive Ref No: ...CLEANING... Wesley Chapel, FL 33545 Start Time: 888-896-9341 FOR YOUR,M°°E .°^ °�A�E° rte- Visit us at www.servicefrstcleaning.com End Time: Customer Info. Service Location Job Info. Name. Carmel Street Department i 3400W.131st Street ,order Group Commercial Phone. "Order SubGroup: Janitorial Cleaning iAlt1 ZIONSVILLE,IN 46077 •Furniture* Au 2: (317)733-2001 I cross street: QTY Description PRICE AMOUNT 1 Janitorial-For the month of November 982.20 982.20 ------_.------.... _....... ._._�_._....._......_ _.._....._...__.. ......_— - — ------- 1 I- I .. .... . -------------.... . --- ...--. ..._____.__......_.._..............— _...__. ..... ...._......__. .....-... -- I .........._._. .....-.............. _........_........._....-----........._...............- --__...._ __......_._._....._....._ .....__ --- I I _..........._ _..__ .-- ...-_................_ ___ - _____ _ _- __ _ - -..._..... _ _.._ ._........_.... . I f ......_. __....._._... ._.................-----__..........._.. ........_.... l I.. ......_.._...... f ............ I _....... - _ --- _ _.._ -._ .___ _..... L_ --. - - -- -. _ l .I l_ .. I.... ._........__I Notes: SUBTOTAL $982.20 TAX ..........._......----......_.................------._.................... _ SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $982.20 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEANING.Customers should be careful in -°° ---- -- - --- -the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL slippery due to damp conditions. ..._......._.....______.._..................._—.—___...._......._.... _.._ --- - GRAND TOTAL PAYMENT AMT _._.......... -..... ........... ...... ...... _....... _.... Work Performed By Date: PAYMENT TYPE REF.NO. _..... _....._..... _..................... Authorization Signature Date BALANCE DUE Thank you for your business Date: 11/8/2013 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)) 11/08/13 153310 $982.20 1 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 Service First Cleaning Payment Processing Center IN SUM OF $ 32145 Brookstone Drive Wesley Chapel, FL 33545 $982.20 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 I 153310 I 43-506.001 $982.29 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 Tl�r d &0 14, 2013 Stre&tMft tnrss'ioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund 357 ww 7 5 Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice M)� Payment Processing Center Order No: 153303 SERVICE FIRST 32145 Brookstone Drive Ref No: ...CLEANING... Wesley Chapel, FL 33545 Start Time: 888-896-9341 Visit us at www.servicefrstcleaning.com End Time: Customer Info.- Service Location Job Info. Name: 'Order Group: J Carmel Utility Department 30 W.Main Street Suite 220 a Commercial Phone. Order SubGroup Janitorial Cleaning A¢t Carmel,IN 46032 Furniture. Att 2: (317)571-2443 `Cross Street: y<- QTY Description PRICE AMOUNT 13 Janitorial-Clean Restrooms Three(3)times each week 25.00 325.00 ----------------........._..._.--........._--------------.._--------- ---......... .............__.—.—._...__._...._.....__....-------._..._......__.......--— ._...._......_._ 5 Janitorial-Vacuum Hallway One(1)time each week 15.00 75.00 I- -- -- -- - - l- --- --....... 1 I-- _........ _........._.._.._ .....---.....--- --- __ ...._.._........... __. -- _ ____ _ -- ---- __ _ --- - _ - - ----------- - I__ 1 --- .__........._.......-- --....._.....---- ---- 1 f I _ -- -.........--- Notes: DISCOUNT $80.00 SUBTOTAL $320.00 TAX SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $320.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN ING.Customers should be careful in -- - - - - -the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL slippery due to damp conditions. GRAND TOTAL PAYMENT AMT .._........_......----..........................—...-...._........._..................-. Work Performed By Date: PAYMENT TYPE REF.NO. Authorization Signature Date: BALANCE DUE Thank you for your business Date: 11/7/2013 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 357097 SERVICE FIRST Purchase Order No. 32145 BROOKSTONE DRIVE Terms WESLEY CHAPEL, FL 66545 Due Date 11/13/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 11/13/201: 153303 $320.00 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 Date Officer VOUCHER # 136845 WARRANT # ALLOWED 357097 IN SUM OF $ SERVICE FIRST 32145 BROOKSTONE DRIVE WESLEY CHAPEL, FL 66545 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 153303 01-7360-08 $320.00 Voucher Total $320.00 Cost distribution ledger classification if claim paid under vehicle highway fund Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice ` . ' Payment Processing Center Order No: 153312 SERVICE F=i R S•-i- 32145 Brookstone Drive Ref No: Wesley Chapel, FL 33545 LEANING— y P Start Time: 888-896-9341 Visit us at www.servicefirstcleaning.com End Time: .:..Customer Info. . Service Location':...... Info:: Name: Carmel Treasurers Department Carmel Treasurers Department order croup: Commercial Phone: One Civic Square :order SubGroup. 4 Janitorial Cleaning . Alt 1 - Furniture: " CARMEL,IN 46032 Alt 2: - .-.. (317)571-2414 Cross Street: QTY: Description' PRICE ::AMOUNT;.. 1 Janitorial-For the month of November 200.00. 200.00 .. ... ....._....... _ ..........................— _ .. _.........--._.........— ---- — ..............--- ....... ._....................... -._...._...__....__._._. I .. ...... -_ ...............------- _ ----- _ _.._.................._.. ... .. ... .... . ............. _ _ -_ _ _ . .. _ l_....._ -- ------ _ - --- . Notes: SUBTOTAL $200.00 TAX --._...-.- —--. _. ....._.._.._ SERVICE ART CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $200.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN I NG.Customers should be careful in .................. — —_....___.........__...._ - the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL ..................._...._._.—..._................._.__.._...._...---.............._.... slippery due to damp conditions. -__—__ __— GRAND TOTAL PAYMENT AMT Work Performed By Date: PAYMENT TYPE REF.NO. Authorization Signature Date: BALANCE DUE Thank you for your business Date: 11/8/2013 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev 1995) 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 �itv�Q_ � l l? �I�-� Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 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 $ r ON ACCOUNT OF APPROPRIATION FOR �01(0 a � Board Members Po#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 16:33 t�L 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 A 0",a t e 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund O_ _ Professionally Unique Services d/b/a Service First Cleaning ` .. FOR YOUR IMAGE FOR YOUR HEALTH Invoice Payment Processing Center Order No: 153307 SERVICE FIRST 32145 Brookstone Drive Ref No: E A N i N�.,. Wesley Chapel, FL 33545 888-896-9341 Start Time: Visit us at www.servicefirstcleaning.com End Time: V . _ _Customer Info. Service Location J64,Jnfo''. .' F11 me, Carmel Communications Department 31 1ST Ave N.W. order croup' Commercial t Phone: � Order SubGroup_ i Janitorial Cleaning Alt 1 Furniture. CARMEL,IN 46032 Alt 2. Street Cross S rr � ✓'�" (317)571-2586 QTY Description PRICE AMOUNT 1 Janitorial-For the month of November 500.00 500.00 _._—. _._..._.........................................._..__......._..._.................................................._.................................... ........................................_.............................. __ -----._.._.. .............. ......... .......--- ....... _ _ 1 1 _ I - I 1 _ ....... . . .......... . .._...... ........ I l ____ ............ ..........---.... I I 1 Notes: SUBTOTAL $500.00 ......................................._............----............................ ..........................................................._.._............................................................................................. .......................I.._..__............... ...... TAX SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $500.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN ING.Customers should be careful in -- - - --— the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL ................................................-.-_....................._......................... --................ slippery due to damp conditions. .......................................----.._........................................._._............................ GRAND TOTAL ......................... ................................_..._............................_..._..._............._ PAYMENT AMT .....................-................... Work Performed By Date. PAYMENT TYPE .................................................................................................... ...................... ._................. _... REF.NO. ........................................ Authorization Signature Date: BALANCE DUE Thank you for your business Date: 11/8/2013 5 g 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)) 11/08/13 153307 $500.00 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 Service First Cleaning Payment Processing Center IN SUM OF $ 32145 Brookstone Drive Wesley Chapel, FL 33545 $500.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Clay Communications PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1115 153307 43-506.00 $500.00 I hereby certify that the attached invoice(s), or I I 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 Director Title Cost distribution ledger classification if claim paid motor vehicle highway fund Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice Payment Processing Center Order No: 153308 SERVICE FIRST 32145 Brookstone Drive Ref No: c LEANING... Wesley Chapel, FL 33545 Start Time: 888-896-9341 Visit us at www.servicefirstcleaning.com End Time: C_ tomer.lnfo. ='L Service Location JobInfo.;= y ,a Name' Order Group - Carmel IS Department 3 Civic Square Commercial Phone Order SubGroup " Janitorial Cleaning P t ....,-......__w.. ....._.-. ,,Alt 1 `Furniture. t-I----} Carmel,IN 46033 E: gAIt 2 Cross Street (317)571-2519 t "Description:: =°.. PRICE' . ; AMOUNT' 1 Janitorial-For the month of November 300.00 300.00 _---------- . ....................................... .........................................................................,.. ... .. ... __ ..................................... ......_._.................................... .............. ........................... ......... . .......................... I __............................... .............................................. ............_....... ................................. . .......... ......................... ...... .................................. I 1 I.......................... ... ..... ............ I ..... .......................... I ............................. ........ . ................. ......................................................... .... . ....... . ................ ............................... I ....... . ......... 1.............................. ..................... ............ ............. I................... 1 .................... ........................ I 1 ............. ................................ ......................... ....................... .. . . ........................... I l 1 ......... ......................... ............................ .......................... ................................................................ ...................._I .............. l _ ............ ............... ................... ...__................................ ................................... ........... ............................. ........................................................ l 1 . ...... l .......................__ .............. I l I I 1 I Notes: SUBTOTAL $300.00 ............. ......................................................................... TAX ..................................._._...... . . ........................................ ......................... . . ......................... .. ................................................................... . ........ ................................................................................. ....... .. ....... SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $300.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN ING.Customers should be careful in the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL ................. .................................................................................. ... slippery due to damp conditions. .............................................................................. ....................... GRAND TOTAL .__................................... PAYMENT AMT ....... ...................................................................... Work Performed By Date PAYMENT TYPE . ................................................................................................................ ..... REF.NO. ....................................................... ..... Authorization Signature Date: BALANCE DUE Thank you for your business Date: 11/8/2013 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)) 11/08/13 153308 $300.00 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 Service First Cleaning Payment Processing Center IN SUM OF $ 32145 Brookstone Dr Wesley Chapel, FL 33545-1656 $300.00 ON ACCOUNT OF APPROPRIATION FOR IS Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1202 I 153308 I 43-506.00 I $300.00 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 Director , IS Title Cost distribution ledger classification if claim paid motor vehicle highway fund Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice Payment Processing Center Order No: 153309 SERVICE FIRST 32145 Brookstone Drive Ref No: ...CLEANING... Wesley Chapel, FL 33545 Start Time: 888-896-9341 FOR YOUR-AGE.POR YOUR HEILTI- Visit us at www.servicefirstcleaning.com End Time: Customer Info. .. IService;L'ocation '. . ,` Job Info. Name Carmel Police Department 3 Civic Square order Group. Commercial Phone: (317)571-2500 OrdersubGrouP: Janitorial Cleaning Alt 1 Furniture: CARMEL, IN 46032 Alf 2 Cross Street: QTY ' Description ;'' PRICE AMOUNT 1 Janitorial-For the month of November 2,225.00 2,225.00 -....._._..._............................—..._.. — —.._..........._._.......................__._._..._..._..................................................................................................._ ._........___ .......... I I l I l _ 1 ............................_........._....._............. ..........._._._.__.__......................._................._............__.............................._........................................ --_ ......................... ................. 1 I l ... ... ..................... I - I 1 _ ........... ----...... I I 1 ................. ............... .............................. ........... ........................ I I l ..............._._............. i Notes: ....._............................................. ............................_.. .......................... SUBTOTAL $2,225.00 . ............. ... TAX SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $2,225.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN ING.Customers should be careful in _........__..... .__......... — the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL ..................... . ......... .......... ..... slippery due to damp conditions. ---......................._..........................._.......................................................................-----........................_......................--........... GRAND TOTAL ......................................_........................................_.._................. ..... ..... PAYMENT AMT ............__.............................._............... -.............._......................... .......................... Work Performed By Date: PAYMENT TYPE ................................................................................................................. .............................. . ............ REF. NO. Authorization Signature Date: BALANCE DUE Thank you for your business Date: 11/8/2013 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)) 11/14/13 153309 monthly payment $2,225.00 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 Service First Cleaning Payment Processing Center IN SUM OF $ 32145 Brookstone Drive Wesley Chapel, FL 33545 $2,225.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 I 153309 43-506.00 I $2,225.00 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 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund Professionally Unique Services d/b/a Service First Cleaning FOR YOUR IMAGE FOR YOUR HEALTH Invoice Payment Processing Center Order No: 153240 SERVICE FIRST 32145 Brookstone Drive Ref No: ---CLEAN I NG---- Wesley Chapel, FL 33545 Start Time: FOR IOUR IMIGE.FOR YOUR HEALTH7 888-896-9341 End Time: Visit us at www.servicefirstcleaning.com /I Customer Info. Service Location Job Info. Name: Order Group. Carmel Redevelopment Commission 30 W.Main Street Commercial Phone: Suite 220 Order SubGroup: Janitorial Cleaning ,Alt 1 Furniture (317)205-7030 CARMEL, IN 46032 Alt 2: CFOSS Street: (317)571-2788 QTY Description PRICE AMOUNT I Janitorial-For the month of August 311.00 311.00 ............ .. ....................... ........... *****_'__- ' 'I............ --- ............ ---- -- ............. .... ......... ....................... . ........ . .. .......... ...................... .......... . ...... ............. . . .. ...................*********** ................ ....... ..... ........................................................ ............................................................................. ...... ............................................... .............................................. ............................... ........................................................................-.............................. ............ .......... .. ........................ . ...................... ------ .. ... .... .. . ....... ........................... . ..... . ............. ------ ----- ........ -- - -------------- . ........... ............................... .................... .................................................................................................................................................................................................................................................................... Notes: ...................................................... ................-_................... ............ SUBTOTAL $311.00 ............................................................ - .............................................- TAX ............................................................... ........................................ - .......................................................................................................................................................................................- . .................................................................................................... .- SERVICE FIRT CLEANING WILL NOT BE LIABLE FOR CONDITIONS BEYOND OUR CONTROL. TOTAL $311.00 INCLUDING THOSE CONDITIONS THAT EXIST PRIOR TO CLEAN I NG.Customers should be careful in the event the cleaning service specifications include floor care,carpet care services,as floors may be ADDITIONAL .............................................................. ............................ ............ .......... slippery due to damp conditions. ................. ................ ....................... ...................................................... ................................................................................................................................... GRAND TOTAL ....................................................................................__.............. .......... PAYMENT AMT ......................... ..................... ....................................... ....... Work Performed By Date PAYMENT TYPE ....................................................................................................................... .......... REF.NO. .............. ............................................................................................ Authorization Signature Date: BALANCE DUE Thank you for your business Date: 10/31/2013 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995) 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 1 SL°Y V ( I r5i C��(ll��/ll Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 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 Se rl�i cP 1--l'of O tAnip IN SUM OF $ '/, 611 ON ACCOUNT OF APPROPRIATION FOR 90 v �) 060 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 31317 2 +350600 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 20/3 I,166r"41� Sign t e Cost distribution ledger classification if Title claim paid motor vehicle highway fund