226127 11/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367559 Page 1 of 1
ONE CIVIC SQUARE NATIONAL GYM SUPPLY CHECK AMOUNT: $111.96
,? CARMEL, INDIANA 46032 5500 WEST 83RD STREET
LOS ANGELES CA 90045 CHECK NUMBER: 226127
CHECK DATE: 11/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4237000 SI859937 111 . 96 REPAIR PARTS
^ , sst3044'tst 83rd Street f — — --
t)s Angeles, to:�Ut1iz, �- SALES INVOICE
1-800-496-7278 (USA&_Canada}'
310•1410•14200(Worldwide) SI-859937 i 10/9/2013
310-410-4220(Fax) OCT 10 20 13
www_vyrnpart.com
Customer ! Contact Ship To
!City of Carmel, Indiana Carmel Clay Parks & Rec
1411 E. 116th Street Kurtis Baum Gartner
;;CARMEL IN 46032 1235 Central Park Dr. East
!UNITED STATES CARMEL IN 46032
Tel: (317) 571-4136, (317) 571-4136 UNITED STATES !
'ax: (317) 571-4136 !
Account Terms Due Date Account Rep i Schedule Date
42978 NET 30 i 11/8/2013 I Mike Montoy , 10/9/2013 I
Sales Order Po # Reference Ship VIA page Printed
SO-762698 —` - - -MC004688 — — Dawn-----' 7:03:18P.,0/9/2013
I 1
L
Item
Description Orders Ship j Prices UM 1 Discount Amounts
ICPPN Customer orovided part number/s. 1 11 50.00EA j $0.001
21LST897 (Headphone Jack Assembly j IOI 101 $]0.2 EA $102.70
3ISH !Shipping Charge 1� li $9.2574iEA $9.26!
I I
4 ISH: Additional shipping charge will
apply for Back Orders and/or Drop j
(Ship parts will apply.
1 j I i i i i li
i
i I i I I II
I
bead-
I I
('88 4
mcoo
jI ! I I I
10% 2.1 - 423-7000
k<5)
Tax Details !Taxable
EXEMPT $0.000 j
Payment Details !
Total Tax $0.00
Exempt $111.96;
I
!!Total $111.961
Payment Disc $0.001,
i
!Paid $0.001
I
j /!Balance $11i.96
I
_MD o c, _e t Format 1999 2006 Everes[5 ftware,Inc.All RI hts Rese—d www.e—estsoflware nc com 800-382-0725
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
Purchase Order No.
367559 National Gym Supply Terms
5500 West 83rd Street
Los Angeles, CA 90045
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
10/9/13 S1859937 Headphone jacks $ 111.96
Total $ 111.96
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.
367559 National Gym Supply Allowed 20
5500 West 83rd Street
Los Angeles, CA 90045
In Sum of$
$ 111.96
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-21 S1859937 4237000 $ 111.96 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
14-Nov 2013
Signature
$ 111.96 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund