26775 American Technology Solutions ®f L arme� INDIANA RETAIL TAX EXEiNPT PAGE
CERTIFICATE NO.003120155 002 0
Ci C PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 02/ _ 7'5*
35-60000972 4�'
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
01-_,01L-4 (.0 -.2 kia�i
1 l '-1-51
VENDOR I. -(0Z S. / I 731 Vd 14 II/— /TOIP
Na-Aery&tt— IL 60010
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
D I k "J— '..os-i-ret
,011. ,
4 ,,,s. ..-.-. '..?# ,--
it v°��°
lrn.: icon
144V V/10,..'•.. 1141,..+ S
,,,_"•........'''.•‘ ,.. 10
s
Send Invoice To;
/-7a /- 3 99 O(4— P4-13
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CE IFY THAT THERE IS AN NOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APP IATION SUFFICI •
T AY F THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
I •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 26775 VENDOR COPY
-411161111.
AMERI N TECHNOLOGY SOLUTIONS C�/
1212 S.Naper Blvd
Suite 119-201 Request for Quote ` „ �;
Naperville,IL 60540
Client: City of Carmel RFQ#: 09301410055
Attn: Accounts Payable
One Civic Square Date: 9/30/2014
Carmel, IN 46032 Phone: 630-548-1970
Fax: 630-839-7252
ATS PrintFreedom Year-end Services
*Qty Description Unit Price Cost
1 2014 W-2 Database Load with Production and Test File 50.00 50.00
1 2014 W-2 Datamap 250.00 250.00
1 ATS MyW-2 Annual Online Hosting and Storage 100.00 100.00
195 ATS MyW-2 Print and Mail Services (includes postage) 0.89 173.55
443 ATS MyW-2 Online Hosting-Employee Consent 0.40 177.20
1 SSA W-2 Electronic Filing Fee for a single EIN 250.00 250.00
1 ATS Provides Client Custom EFW2(Client does Indiana State Filing) 300.00 300.00
*Reflects Estimated Quantity Total Estimated Cost: $1,300.75
An Advance Deposit of $0.00 for Print and Mail Services is due by 12/01/2014
a TS-- 444.:„40/ecttic , (Dbc-/(6 7”/
Purchase Order# Client Signatur Date
Please sign and fax RFQ to:ATS Sales Please Mail Advance Deposit Check to:
Fax: 630.839.7252 American Technology Solutions
Attn: Accounts Receivable
1212 S. Naper Blvd, Suite 119-201
Naperville, IL 60540