26483 American Technology SolutionsCity of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032-2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
1
PURCHASE ORDER NUMBER
72$ g3 .
THIS NUMBER MUST APPEAR ON INVOICES,, AIP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO. .
VENDOR NO.
DEESCRIPTION
N.
VENDOR
ij(ectichktintS SHIP
TO
C(trit--r-ral-CSU(Ler
_ -J
CONFIR•ATDN
' BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
'EXTENSION
ju Obqiccs - ,90 (ao
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
03494
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT 1 AMOUNT
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE N ITI I CHAPTER 99, ACTS 1945
AMU ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26483
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE no
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY CERTIFY THAT THERE IS AN UNOELIGATED BALANCE IN
THIS APPRISPR TIW ON SUFFICIENT TO PAY FOR THE ABOVE ORDER.
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A1-1EXICAN TIC I INC)Li 4iLLt.: ION : ::.
1212 5_ Naper Blvd
Suite 119 -201
Naperville, IL 60540
Ph: 630 548 1970, Fx: 630.839.7252
Client:
Contact:
Address:
City of Carmel
Diana Cordray
One Civic Square
Carmel, IN 46032
Phone: (317) 571-2414
Request for Quote
Quote# 12E010055071012
Date: July 10, 2012
ATS Contact: Mark Richier
Phone:
Fax:
630 -545 -1970
630 -839 -7252
ATS PrintFreedomTM MyW -2 Portal with Print and Mail Services - 2012
Qty Description
Unit Cost
1.0 2012 W -2 Database Load with Production and Test File
1.0 2012 W -2 Datamap
1.0 ATS MyW -2 System — Annual Hosting and Storage
*492 ATS MyW -2 Employee's with consent (receive W -2 electronically)
`149 ATS MyW -2 Print and Mail Services (includes postage)
550.00
$250.00
$100.00
$0.40
$0.86
1.0 SSA Electronic Filing far a single EIN $250.00
1.0 Provide Custom EFW2 Format (Client does Indiana State Filing) $300.00
* Estimated Quantities
Total Estimated Cost:
Client PO #: Client Signature
Please fax signed Request to:
Attn: Mark Richier
Fax: 630.839.7252
$50.00
$250.00
3 100.00
$196.80
3128.14
$250.00
5300.00
$1,274.94
Date
Thank You! — PVe truly appreciate the opportunity to work with you.