227021 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 364209 Page 1 of 1
ONE CIVIC SQUARE JOHNSON HEALTH TECH NA INC
CARMEL, INDIANA 46032 1600 LANDMARK DRIVE CHECK AMOUNT: $2,077.94
'P COTTAGE GROVE WI 53527
CHECK NUMBER: 227021
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4350000 9001320512 2, 077 . 94 EQUIPMENT REPAIRS & M
Johnson Health Tech NA Inc. INVOICE
® 1600 Landmark Drive Document 9001320512
Cottage Grove,WI 53527
® N ® Phone: 608-839-1240 Date 11/14/2013
Fax: 608-839-1260 Page 1 of 1
Purchase `
Bill-To: 33004423 Description ` V ��1 r S Ship-To: 33004423
P.O.# nom 4- _ P or F
Clay Park and Rec-Carme�L # 1 og b_21 - 4-3,; GC,0p Clay Park and Rec -Carmel
Collene Broderick Budoet buy—, c 1235 Central Park Dr E
1235 Central Park Dr E Line`Descr —Carmel, IN 46032
Carmel, IN 46032 purchaser - Date_
Approval 1`2-7//3
Comment: CRM User:John Schuepbach;CRM Order#:ORD-674883;Case#:CAS-578943 4N9JP4;
Shipping Comment:
Purchase Order No. Sales Order No. Sales Person ID Shipping Method Terms Due Date
36355 100781199 GL TM(GreatLakes-TM) UPS GROUND 100%PTS 11/14/2013
LN# Qty. Model Number Item Number Description List Price Net Unit Price Ext.Price
10 17 0000093108 Control Box;TV07 119.88 2,037.96
FDEC IR
2 2013
Remit To: Discounts 0.00 Freight 39.98
Johnson Health Tech NA Inc. Misc./Duty 0.00 Freight Disc. 0.00
1600 Landmark Drive Other Fees 0.00 Tax 0.00
Cottage Grove,WI 53527 Subtotal 2,037 96 Total;l1SD ; ° 207794=
A Service Charge of 1.5% Per Month
Will Apply To All Delinquent Balances
GHOMIZON
FITNESS F I T N E S S
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.
364209 Johnson Health Tech NA, Inc. Terms
1600 Landmark Drive
Cottage Grove, WI 53527
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
11/14/13 9001320512 TV Repairs 36355 $ 2,077.94
Total $ 2,077.94
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.
364209 Johnson Health Tech NA, Inc. Allowed 20
1600 Landmark Drive
Cottage Grove, WI 53527
In Sum of$
$ 2,077.94
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT WTITLE AMOUNT Board Members
Dept#
1096-21 9001320512 4350000 $ 2,077.94 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
5-Dec 2013
T
Signature
$ 2,077.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund