226073 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367001 Page 1 of 1
i ONE CIVIC SQUARE CAPITAL ONE COMMERCIAL
(o CARMEL, INDIANA 46032 PO BOX 5219 CHECK AMOUNT: $419.98
9*,ren c� CAROL STREAM IL 60197-5219 CHECK NUMBER: 226073
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER. INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 349 . 99 BUILDING REPAIRS & MA
1095 4238000 69 . 99 7003731100072984
e
Please Direct Inquiries To: 1-800-220-8594
ycO COSTCO
W�i101iESALE
Account NumberNeuv Balance Payment Due; Amount PastDue Due Date
7003-7317 0007x2984 $41,91.98. $i00 4.00 11%20/2013 s
?' Billing Dale .. Credit Line;! Available Credit
1012W.013 $5,OR0 $4 580.,02
TDD/Hearing Impaired: 1-800-365-0186
STATEMENT OF YOUR ACCOUNT
0
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FIN ANCE CHARGE S�JMMARY
0
U Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo
Q Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire
Description Number Balance Rate APR Periodic Rate RATE Due
C, Reg 00014 $28.00 0.00000% 00.00% $.00 00.00% $419.98 $.00 11/26/2013
0
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ACCOUNT DETAIL ^
° Transacfton Transacf'ion Iniroice aJser RC? Transacteon.
..........
........... Descrfptiort Number lD Number Amounfi. ..
o ... .. ...... .. ... .. .. ..
10/11/2013 COSTCO WHOLESALE-346 035163 00015 $452.88
00015 SUBTOTAL: $452.88
10/11/2013 PAYMENT-THANK YOU 00001 $470.41-
10/16/2013 RETURNED MERCHANDISE 00015 $32.90-
Enjoy the simplicity and convenience of managing your account online. Manage your account at www.hrscommercial.com
C
FR� EW�7,5�
NOV Q4 .2.913
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.
CMSFC01 COSTCO
MFHMEgALE
ACCOUNT SUMMARY BALANCE SUMMARY
Outstanding
CURFiENfi, 1:24 DAYS?PASTDUE ;3059 DAYS PAST DUE ! Transaction $470.41
+New
$.00 $.00 $.00 Purchase(s)/Debit(s) $452.88
+New Fees $.00
60$9 DAYS.pA..ST DUE: 90-118 DAYS PAST:F3UE 120 149 MAYS PAST DUE:::
..... - ..... e Charges $.00
$.00 $.00 $.00 Payment(s) $470.41
....... ... ..............................................................................
150 178 BAYS PAST DUE 180#DAYS;PASTDUE Credit(s) $32.90
s
g $.00 $.00 =New Balance $419.98
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Page 2 A2
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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!
CCraa❑❑000❑❑❑❑L—ILJLJ❑❑❑❑❑❑❑❑0000❑❑
Email Address
❑000❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑
Street Number if an Street Name or the words TO BOX" Unit or PO BOX Number
❑❑1 1E] ❑❑�❑❑❑❑❑❑❑ ❑❑❑❑
C ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ So❑ n❑❑❑❑
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
10/26/13 7003731100072984 Small tools S 69.99
10/26/13 7003731100072984 Building repairs & maintenance $ 349.99
Total $ 419.98
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.
(Costco)
367001 Capital One Commercial Allowed 20
P.O. Box 5219
Carol Stream, IL 60197-5219
In Sum of$
$ 419.98
ON ACCOUNT OF APPROPRIATION FOR
109 MCC
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1095-3 7003731100072984 4238000 $ 69.99 1 hereby certify that the attached invoice(s), or
1093 7003731100072984 4350100 $ 349.99 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
14-Nov 2013
Signature
$ 419.98 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund