HomeMy WebLinkAbout227124 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367794 Page 1 of 1
ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $262.41
CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD
MEDINA NY 14103 CHECK NUMBER: 227124
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4235000 35764 262 . 41 BUILDING MATERIAL
® e f o r m Invoice#: 35764
11601 Maple Ridge Road �a�. Invoice Date: 10/29/13
Medina, NY 14103 CEIVE.D
800-528-1398 PO M 36258
Payment Terms: Net 30
Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attm Susan Beaurain Email: sbeaurain @carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Monon Community Center
Unit Net Net
Line Description Quantity Price Price Ext
1 Type 1.2: Rm ID 1 Line with 8.5x11 Slide-In F5513-N1 1 212.41 212.41
2 Insert Template CD (Overheads) 1 0.00 0.00
3 Punchlist Installation 1 50.00 50.00
3(c:25$ IF
� Cq I_wx-:4.- O p o i@k Net Total: $262.41
Balance Due (USD): $262.41
Terms are Net 30. Past due accounts are subject to 1% interest per month. We reserve the right to hold future orders or
ship future orders COD if terms are not adhered to. Purchaser is responsible for all fees and expenses including but not
limited to, attorneys and collection fees incurred by Takeform in the enforcement of this agreement.
Credit cards accepted. Please complete form below and fax to Accounts Receivable at 585-798-8889
Payment Options: Carmel Clay Parks&Recreation
C]Visa MasterCard Discover American Express Invoice #
Balance Due: $262.41
Cardholder's Name:
Card Number: C V V 2#:
Expiration Date:
Card Billing Address:
Signature:
Print Date:10/29/2013 4:33:29PM Page 1 of 1
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.
Takeform Terms
11601 Maple Ridge Road
Medina, NY 14103
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
10/29/13 35764 Additional interior sign 36258 $ 262.41
Total $ 262.41
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.
Takeform Allowed 20
11601 Maple Ridge Road
Medina, NY 14103
In Sum of$
$ 262.41
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1091 35764 4235000 $ 262.41 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
Signature
$ 262.41 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund