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HomeMy WebLinkAboutPURCHASE ORDER/PAYMENTS VOUCHERS Attach supporting documentation w the back*this form ���~�� ���� ��8� �������K �� ���� STATE- ~ . ~~ ~~~ ~~~ °°~`" ������ BUDGET [Y PURCHASE ^�����������U����� ��x��������DOCUMENT NUMBER . ~~. .~~~ .~ ~==�� �~" °�~=~n ux v m_x o om,�~o� u � n�p�w��n n�~xn DATE ^nnro PERIOD(m°*y) 2008 09/11/07 58308001120 VENDOR CODE Aosmo, m*ys VENDOR NAME AND ADDRESS BILL rn ADDRESS(ORDERING AGENCY) SHIP rnADDRESS WATERLOO, CITY OF EMERGENCY MANAGEMENT 715 MULBERRY STREET � 7105 NW 70TH AVE WATER| UO IA 50703 _ , JOHNSTON, IA 50131-182 rsnmm poe ORDER APPROVED o, Phone No: 000unxsrovsomEnmCso IOWA H[MELAND R����K�Y Julie Nishijima Sep 11, 2007 DATE INITIALS oo^wr/r, VENDOR'S INVOICE DATE VENDOR'S INVOICE NUMBER nnosnso nsyswso UNIT OF ' nESCn/pnow UNIT PRICE TOTAL PRICE MEASURE PA DRI688 2117..5000 2117.50 .00 FED SHARE $2062.,50 .00 SUBGRANTEE ADMIN $55 00^ .00 .00 PKG NUMBER 66 ..00 PROJ WKST 943 .00 .00 .00 ..00 .00 .00 .00 .00 .00 2j17.50 CLAIMANT'S CERTIFICATION 0OCUK8E@TTQTAL /oERnFY THAT THE ITEMS FOR WHICH PAYMENT AGENCY CERTIFICATION pRopsn,AND nonnsc�AND wo PART op=",AND THAT THE CHARGES ARE ns^v»w^»Ls� /Ccnnpv THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE THIS,~/.,HAS .,��" ,°.,. CORRECT AND SHOULD oep^mppomn,spumne^prnop�mrsnv, CLAIMANT'S SIGNATURE ' AUTHORIZED SIGNATURE THE roLLowwonsLooARE nmonTs^000vwnwoUSE ONLY oonr/pe voowowosn noro�z --c�upno nvoscr xnrmw posmp pv � (PO",pv) - /wr /wraeusn /wrne's« � V 58308001120 0p/��/07 SF) �p' 8 NEW/MOD /w«rn r'ps /mo pvwo ^aov ^�"`' VENDOR CODE ^unnmennms rm/mwC^ron s^wo o\ , 42600532�00 '""''»"'"only n/N/ TEXT/n"'sonly) REF ooCTYPE REF norNUMBER REF oncLINE comm VEND INVOICE v COMMODITY CODE oorowrp^cr uwc =ono *uo, nnu sus ^ury nono ove pvwo n^ur ovn JOB NUMBER nep ov^wr/r,/ ,o oenrn/=mw »«a nan» oeur um UNITS AMOUNT /m n, 7000 PW _ ~ 0491 583 7000 SA 55.09 - - 07-352 K� �� U o »*._ � .~ ~~"°"~~.� . TOTAL | Zl17 5� GAX WARRANT# AUDITED BY nishiji PAID DATE ' 01 p r n. cO , Tu. 8 ii U O -.444 U o U m 3 i e o o e o L fb O O O O O U m o 0 O O O O O O O O 1 0 1j m ce m g w a v, j.;'. of N M M O CO M O N- CD Q r`, tO (7 (O Q 1� O co "` N n r CO M N N N N N .' w 69 fA to EA EA fA E9 w z'< n l N Y 0 N U 0-3 0 0 U o 0 '..0 r N coto aq a w 0 U W c d X z e9 w W(/)co Z j m on 2 cn rn 8 o m 8 o 8 I-Lii& 3 = N r N N N O oN CC (n %...L j N O N o� O .- co~ Q ry Q C N N Q Z �. :Q m W U E. CO Q '.,_ f9 <9 fA e9 E9 co as. H, 69 69 a o_ N a�0 c o 0 .0 S a N L U Q d N m 9 CC m d m O CD m. N C c n a o 00 o Ca 0 - 0. N N F co co o o m m v '0 m : co rn N m n v m . 0.. n N ry N M (D m o 0 a4 0 m O 0ri co 0 of &! M M N N c; -. 9 of9 o f9 t9 t9 H, ' f w '* 0 N to N m O ,- O o, ya'm' 0 4.- m m , 0 O w- 8 2 04 m 0 2 O 2 8 L W W. C N ' Q 14 o y1±+ N r 2 ry Le;V N N p r �x 69 69 69 6969 69 69 69 w ' ` O O O O O O O O N N N N N N N N - v v Q o Zry a Q -,-` o 0 0 0 0 0 0 o w t o U U . U U U N U o g i.„< < O m O m O W ry U u Op 0 0 0 0 0 0 0 0 n a m . m n tO Q CO m CN') M V 44, 3 N Q ID CO CD CO CO 0) 0 00 CT o L o U000HU 00 00 00 0oi 0 00 00 oD LO CD �1J NiA NNQN V 4 OV ON NN CNCVN co co MM O O O O O O ACCOUNT NUMBERS State of Iowa Warrant 0991-08-583-00O-7000 -4125 VOID L MONTHS AFTER 09-19-07 No, 62928222 0491-38-583-000-?000-4125 TO THE Treasurer of State Des Moines, Iowa 50319 33-72730 Pay to the order of 1 DEPARTMENTAL REFERENCE NO'S AMOUNT WATERLOO, CITY OF 08583255005 XxxXX532700 2 $*****2,117:50 I CLERK/AUDITOR OFFICE 58308001120 715 MULBERRY ST WATERLOO IA 50?03-5?83 4 ' 4F08A9A3A7AAA0 DEA 0C=ADMi(`$g:1+i,`",f t e AUTHORIZED SIGNATU I:0 ? 3000 ? 231: 6 29 28 2 2 20 Niir Attach supporting documentation to the back of this form STATE OF IOWA GAX B tiGET FY PURCHASE ORDER/PAYMENT VOUCHER DOCUMENT NUMBER DATE ACCTG PERIOD(mm/yy) 2008 0 /14/07 ".JW,M8000561 VENDOR CODE AGENCY NAME VENDOR NAME AND ADDRESS BILL TO ADDRESS(ORDERING AGENCY) SHIP TO ADDRESS E ri.1.00 C i Y ii : Y MA k! ci EN'f 1!5 BERRY STFEET 71 05 N tt1 WATERLOO, IA 5070 JOHNSTOP, IA 501?i,1-1B2 TERMS FOB ORDER APPROVED BY GOODS RECEIVED/SERVICES h *IOWA HUNi.41r.d0D aVORY 14, VENDOR'S INVOICE DATE VENDOR'S INVOICE NUMBER QUANTITY ORDERED RECEIVED UNIT OF DESCRIPTION UNIT PRICE TOTAL PRICE MEASURE I E.A Pti C AOC 6 . 1 FEDERAL SHARE 0.00 .00 '..:JUI1GrANTEE 00 VASE ct IEE'r IV A 00 „00 00 .00 00 „00 .00 .00 .00 00 DOCUMENT TOTAL CLAIMANT'S CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT IS CLAIMED WERE FURNISHED FOR STATE AGENCY CERTIFICATION BUSINESS UNDER THE AUTHORITY OF THE LAW AND THAT THE CHARGES ARE REASONABLE, I CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE PROPER,AND CORRECT,AND NO PART OF THIS CLAIM HAS BEEN PAID. CORRECT AND SHOULD BE PAID FROM THE FUNDS APPROPRIATED BY: CLAIMANTS SIGNATURE AUTHORIZED SIGNATURE THE FOLLOWING FIELDS ARE FOR STATE ACCOUNTING USE ONLY DOC TYPE DOC NUMBER DOC DATE ACCTG PRD BUDGET ACTION PO SHIP PV INT INT SELLER INT SELLER (PO or PV) FY NEW/MOD INSTR TYPE IND FUND AGCY 3: V 58WW?)00561 08/1 A./0.2 SPI -0 8 VENDOR CODE ADDR OVERRIDE F/A INDICATOR EFT IND I.EXT-pAiSolAY/N) TEXT(po's only) 42005::;2700 REF DOC TYPE REF DOC NUMBER REF DOC LINE COM LN VEND INVOICE# COMMODITY CODE GS CONTRACT LINE FUND AGCY ORG SUB ACTV RSRC SUB FUNC OBJT SUB JOB NUMBER REP QUANTITY/ 1/D DESCRIPTION AMOUNT I/D P/F ORG RSRC OBJT CAT UNITS 1 0491 Mn 1000 SA A 12:3 1 6 2 2 6 0 0 8 07-352 DOCUMENT TOTAL GAX WARRANT# AUDITED BY PAID DATE , 1L). E o 0,A it A C 3 m m 8 -58 • ro o Pt U 7 q m a � C +r m A N a N VA c7, h m Z O O t T N V1 n isi 00 ,,w O 6:" a-° mo L`. to Q O C 0 0 O fr v'-"-? ` " li OU 4k w cc',Jai w r t% z N N 0 fp . Z,'o G au, m m ro •:° Q 0WwC NL 0 m m0 0 coa sQri .. oZ £ M f U w ,< 0 o. E Da .;_ N N a N N N $; . Eg a N W C— m t.W W W � a 4.- n 5 o;%+a o k N b, Cr, N ea0 N yY� C co h Np N O O S 7ln�,, N N . r ti E orn r o m 5- Q J F f Am e<, U N ,3, W O O 00 'O gJ N ri 6 6 A A A of 0 0 0 0 0 0 0 ACCOUNT NUMBERS I State of Iowa Warrant 0491-08-583-000-7000•.4125 • VOID 6 MONTHS AFTER 08-21-07 No. 62884543 TO THE Treasurer of State Des Moines, Iowa 50319 173 02 Pay to the order of DEPARTMENTAL REFERENCE NO'S I AMOUNT WATERLOO, CITY OF 085832268M XXXXX532700 6 #***** CLERK/AUDITOR OFFICE 58308000561 3 163.],6 I 715 MULBERRY ST WATERLOO IAA .. .. 50703-5783 t = .� 9 , 64999A770t3060 ui AN r� •:.;,t itPT.t7E Ai� it�.SVic cJ 1.s� ct AUTHORIZED SIGNATURE I:0 ? 3000 ? 231: 6 288451, 3�i� Att documentation- to the���f this ���~�8 �~�� ��0� 0�����»� ����� . STATE x �� m��u— �m������ n�m�m�� . , BUD��� F� �NN����� ��� ^���������U���� �����DF�UMEKTNUMBER - ���m��mm^��� v���������� m n�o � ���N�� -- DATE ACCTG PERIOD��w 200Q 07/31/07 58308000307 VENDOR CODE ^eswo, wmwe VENDOR NAME AND ADDRESS BILL ro ADDRESS(ORDERING AGENCY) SHIP roADDRESS WAlER�'OO, CI�Y GF E#ERGENCY MANA8EM��NT 715 #ULBERRY STREET 7105 NW 704'11 AVE WATERLOO, IA 50703 JOHNSTON, IA 50131 '182 rsnmo FOB ORDER APPROVED e, s0000mos/vsmnsnv/rso Phnne No: IOWA H[MElAND pQ��0wgYY Steve Loren, Jul 31, 2007 »^/e INITIALS INVOICE DATE VENDOR'S INVOICE NUMBER "RJE VIED ���� ����'`v�� .��`�� �./�'�*�'i'/'^`�D�Cn�no"?����8/�- .'�`��'� c'�,�f�' ����o ""E�AS""= . '^. '' `` . � �^/ ` - � , '�^ "~ 1.0� 1 .00 EA PUB ASST G5507.190 85507.19 FED SHARE� 82817.31 .00 SU8GRANTEE ADNN: 2689. 88 .00 PACKAGE: 50, WORKSH[ET:463,514,626,633,635,637 .00 .0� ' '0@ ~ .0� '0J .00 .00 .�0 '00 '0g 8OCUKNENTT0TAL ^ ' CLAIMANT'S CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT m CLAIMED WERE FURNISHED FOR STATE AGENCY CERTIFICATION BUSINESS UNDER THE AUTHORITY op THE LAW AND THAT THE CHARGES ARE ns^sow^eu,. /CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE pnopsn.^woCnnpsor.^mownp^pnorr^mow/mx^sasswp^m CORRECT AND SHOULD as PAID FROM THE FUNDS APPROPRIATED BY: CLAIMANT'S SIGNATURE AUTHORIZED SIGNATURE THE,nun%nwa FIELDS ARE FOR STATE ACCOUNTING USE ONLY onor,ps uoowvmosn onCo^rc ^ooru,no uvoac, ^rnow PO SHIP ry /wr /w`esusn /wrxsucn (PO orpn " wcW/won /wmn "ps /wo ,owo ^ao, | V -�G`'08000307 07/`]/07 SF\ 2008 VENDOR CODE Auonovsnn/os nw/wn*^run sprmm rsxr-Wsam'mw` 005327�0 rsx w"��w 426 FEE nocTYPE REF 000NUMBER REF oovLINE Comu" VEND INVOICE* COMMODITY CODE sxvowrn^or uwn rowo ^GC° 'ona 000 «on/ monu ouo puwo oour e»a »oewomosn REP QUANTITY mu osaon/prmw �' `��,'mOuwr Ito n� .` . ons nono on� `^ ' . ' 'c� .`^ownn '- � �491 �83 7000 PW 4125 828�7.3] 9491 'j83 7000 8A^ � � ^, 4125 � ,� ` , � � _.'','�� .' � ' ,�-�_' 2689`88 ~` ` 07.352 DOCUMENT nOn *" A 855�7 l9 A ' n�m��� ���� �� WARRANT# AUDITED BY PAID DATE O 0 0 O O O O O O O O 0 /4(//7 N N N N N N N N N N N --° fly ' g E O N , l D ,; a �,r� �^..® Q O O O O O O O S i 0 j.b; `Ln.."r 2 0 m co alw > D Q. r. (N-°a - p c 8888888 v v .i v .i v t It ( N N N N N N N N , V1 I n W -+ CO p iv N N 49 44 co N 69 N ,?4, 0 • 4 O m (T O m q_ .vi 0 m g' W (T N 40 O (T p f0 V O N (-4 it. gf4 .Z a W taD m+ Ol `�a. a o 4, N 69 N N N 4, N'n to -4 N .m a co O m o O 'O - c 5.1 mo P " 9D al ?'; U G7C :4 <O V O :-.1P W OC aG m W a.m �'A' m m 0 0 0 0 0 0 • • 3 m p� p� p� f� p� ••To �7 V N N N m N v. !A N VI '.. C (A <g C �� 01 IV AI A __ D 3 Z ce i.� � a cn in m u w N m Ov N M .Z7 y t� m v v' e A T ,3 ^t"+ i.) i0 m N A e' w a Z. • S m (� ` Z '`� _ W N N N N �Z CO 4.D n 21 0m a el co N .7. q 00 ti 1�1\` 2 cb W c. O O 0 n P r c a a 1 »: V ...43 V p r 8 8 $ ' 2. \` 1 !� N N N N V. N N N 1 \\\fff 111 1 m 4 .... pm� pN 0CTT mN `n CA f t0 yN, {O.�f �OyI f�pn X:}Q!. 4 f m N - t(0 O Of IJ Ov'- Cr'. �q- \ d N LA? ,i 3 w Z LN -- V t!. -Th4 ttf--4.1 ,, ,- 0 1,r, v$ . ":i i b_ m SO tit 8 fT MONEY FROM: , � a Prepared by/Date,[arn E se Return a Duplica -eceipt r4r ,€,.a Isa { fi MP, DESCRIPTION: _ fOr ",....C;r:..,...,.,-<..e..' a r w J'7r�rfxFai1e 7o M1111111111 City Clerk/Finance Office DESCRIPTION: I City of Waterloo 715 Mulberry St Waterloo, IAA 50703 8/14/2007 Receipt Number; N4801533 15:53:27 Received By . : CTY09 Received From: FEMA REIMBURSEMENT-ICE ST AIRPORT HANGAR FEMA 20 597.36 @10 29 7700 3345 ,` • FEM4 REIMBURSEMENT-ICE STORM PARK FENA GRUNT 41 326.47 0010 37 4100 3345 s 2 0 1 5 9 7_ 3 6 FT MA REIMBURSENENT-It'd STORM IRAFFIC OPER FEIA GRANT .._ r.- 'g21.62..- 1 , 326 - 47* E6 17 7120 3345 921 6' 640 _ 62 r FEND RFINEUR" STOW 4 9 TRAFFIC OPER END ORPNT�TU��! 1' ' 961 - 42= 266 17 7120 3345 E,6 .43 10 059 r3 3 FEt REINBURSJENT-ICE STORM r POLICE. FEMP 5,9E1.42 F3 5, 5 / . 1 9 0 010 11 1100 3345 8 5 , 5 FEM t REIMBURSEIENT-%CE STOW7 1 9- FIRE-FEND GRANT G 10 0 9.83 0 . * 010 12 1400 3_4 ' FEMP REIMBURSE T-ICE STORM •* Receipt Total `___ 35,507.I'? Amount Tendered 05,507.19 Change .00 Payment Received: Ehec' : 85,507.19 ACCOUNT NUMBERS State of Iowa Warrant 0491-08-583-000-7000-4125 VOID 6 MONTHS AFTER 13806"07 No. 62$62034 0491-08-583-000-7000-4125 T° Treasurer of State ' 33-72 Des Moines, Iowa 50319 730 Pay to the order of DEPARTMENTAL REFERENCE NO'S AMOUNT WATERLOO, CITY OF 08583212013 XXXXX532700 9 $****85,507.19 I CLERK/AUDITOR OFFICE 58308000307 715 MULBERRY •ST WATERLOO IA 50703-5783 • " l 8F4339A79A8600 , NI011JEK • ��-.• ��..�.tit DEPL OF ADMIN.SEFMCES AUTHORIZED SIGNATURE 1:0 7 3000 7 2 31: 6 286 203411' Attach supporting documentation STATE OF IOWA to the back of this form �•dl0 GA 4,,,,,, •YAN0 BUDGET FY PURCHASE ORDER/PAYMENT VOUCHER DOCUMENT NuMBE. = DATE ACCTG PERIOD(mm/yy) VENDOR CODE AGENCY NAME VENDOR NAME AND ADDRESS BILL TO ADDRESS(ORDERING AGENCY) SHIP TO ADDRESS {atr=l i f:I'I_.(:I(s, t:::i f'i f?I= F:adF:RGENri II•if i O,in r 715 Mt_fl..)I:.i tIY `s-I REF:..f 7105 i,,{ _•;: ! we,' Elf'!.(::{;)., •F" 50 .j ,1i:11 IW>I fii•!, 1 r^ ri j1.'J.--1f:;: . TERMS FOB ORDER APPROVED BY GOODS RECEIVED/SERVICES i'I oI flue J01.J.a M-Iflte�a4 )\JI? IrotR!�e °{Y cr.. F:t1,.{; ;. i f.nia r '... '2007 VENDOR'S INVOICE DATE VENDOR'S INVOICE NUMBER QUANTITY ORDERED RECEIVED UNIT OF DESCRIPTION UNIT PRICE TOTAL PRICE MEASURE 00 00 t ,: 11t);{ 40 4,49..2%10 40 '-9,;_'4 00 F-EfiI._. ...�.:__:_., _.... _.i0 00 00 ':*;3 I10 DOCUMENT TOTAL CLAIMANT'S CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT IS CLAIMED WERE FURNISHED FOR STATE AGENCY CERTIFICATION BUSINESS UNDER THE AUTHORITY OF THE LAW AND THAT THE CHARGES ARE REASONABLE, I CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE PROPER,AND CORRECT,AND NO PART OF THIS CLAIM HAS BEEN PAID. CORRECT AND SHOULD BE PAID FROM THE FUNDS APPROPRIATED BY: CLAIMANT'S SIGNATURE AUTHORIZED SIGNATURE THE FOLLOWING FIELDS ARE FOR STATE ACCOUNTING USE ONLY DOC TYPE DOC NUMBER DOC DATE ACCTG PRD BUDGET ACTION PO SHIP PV INT INT SELLER INT SELLER (PO or PV) FY NEW/MOD INSTR TYPE IND FUND AGCY t, I`f `..�.{. ,liE � .. :,J d4_: SE. .,'ih:ri.. E 1 VENDOR CODE ADDR OVERRIDE F/A INDICATOR EFT IND -pn!sY/N) TEXT(po's only) REF DOC TYPE REF DOC NUMBER REF DOC LINE COM LN VEND INVOICE# COMMODITY CODE GS CONTRACT LINE FUND AGCY ORG SUB ACTV RSRC SUB FUNC OBJT SUB JOB NUMBER REP QUANTITY/ 1/D DESCRIPTION AMOUNT I/D P/F ORG. RSRC OBJT CAT UNITS '' -t7 491 583 7000 SA 4125 5$..74 07-352 DOCUMENT TOTAL I aJ•'%i:h=T! ..74 GAX WARRANT# - AUDITED BY ;n PAID DATE 0 7 . x / § \ .4 \ G , 8 » \ \ « \ ) $ \ \ � \& k 444 @: k\ j E p / i / aJ a• / (co ui I)\ ! \\ \\/ ®$ C. G55 CC/ ct ) (/ ° k / ! c a J * \ 3 t # / / J ! m , a_ ) | C. e _ j \ } \, \ , \ \ if. / , » tk } } /( \ \ $ C. © ( -) Z Q �} ` � !} ) } . � :'`{} \± 1 � } k }} ; GQg ( 7 $ ] ka • i ) ® AN @ /ai \ g ¥ /\ \ § a_ 0 , , , = 0 0 5-� / �0 33 4/5' City Clerk/Finance Office City of Waterloo 715 Mulberry St Waterloo, IA 50703 6/22/2007 Receipt Nuober: 070010309 13 46:04 Received By . CTti`09 Received From: STATE OF IOWA SAWITN GARBAGE FEMR GRAN 40,449.24 525 i5 5400 3.345 STATE OF IOWA FEEA {PRIL 20107 Recaiut Total . . 40,449.24 Arount Tendered . 400 449.24 Ctaoge . . . . .00 Favtrer+ rtecei7ed: Chest: 40,443.24 ACCOUNT NUMBERS I State of Iowa Warrant 11-07-583-000-7000-4125 voID6 MONTHS AFTER 06-15-07 No. 62783312 11-07-583-000-7000-4125 TO I THE Treasurer of State 33-72 Des Moines, Iowa 50319 I 730 Pay to the order of I DEPARTMENTAL REFERENCE NOS I AMOUNT WATERLOO, CITY OF 07583164002 XXxxX532700 2 $****40,449.24 I CLERK/AUDITOR OFFICE 58307004578 715 MULBERRY ST WATERLOO IA 50703-5783 �tE " 3AOA9AF7664A0 1'roivaac� ., ,..t ., IR.DEFT.OF A.DMM.SERVICES I, AUTHORIZED SIGNATURE 7 3000 7 2 3,: 6 27533 L 2tl' ASH RECEIPT CODING MONEY FROM: ^4e% Prepared by/Dat P (o w--0 G% -Please Return a Du plicate Receipt vc s',, ;( DESCRIPTION: e+�_ 21 i i :f AJ�C tb r' , �i�i t%° f`t ro�I r • y . J DESCRIPTION: Attach supporting documentation to the back of this form STATE OF IOWA GAX BUDGET FY PURCHASE ORDER/PAYMENT VOUCHER DOCUMENT NUMBER DATE ACCTG PERIOD(mm/yy) 200F3 59M8001607 VENDOR CODE AGENCY NAME VENDOR NAME AND ADDRESS BILL TO ADDRESS(ORDERING AGENCY) SHIP TO ADDRESS WATERL001 CITY OF EMERGENCY MANAGEMENT 715 MULBERRY STREET 7105 NW 70TH AVE WAIERLOO. IA 5070:!!', JOHNSTON, IA 501M-182 TERMS FOB ORDER APPROVED BY GOODS RECEIVED/SERVICES Phone No: P„E.W..(tItIMO.Y DATE INITIALS Nishijiffl Sep 28, 2007 VENDOR'S INVOICE DATE VENDOR'S INVOICE NUMBER QUANTITY ORDERED RECEIVED UNIT OF - DESCRIPTION UNIT PRICE TOTAL PRICE MEASURE 1 ,00 1”00 PUBLIC ASSISTANCE DR 1688 01118.550 01118,55 .00 FEDERAL SHARE „00 .00 .00 .00 PROJ WKST 62 .00 .00 ,00 .00 .00 .00 .00 .00 .00 1S„7J DOCUMENT TOTAL 81 1 CLAIMANT'S CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT IS CLAIMED WERE FURNISHED FOR STATE AGENCY CERTIFICATION BUSINESS UNDER THE AUTHORITY OF THE LAW AND THAT THE CHARGES ARE REASONABLE, I CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE PROPER,AND CORRECT,AND NO PART OF THIS CLAIM HAS BEEN PAID. CORRECT AND SHOULD BE PAID FROM THE FUNDS APPROPRIATED BY: CLAIMANT'S SIGNATURE AUTHORIZED SIGNATURE THE FOLLOWING FIELDS ARE FOR STATE ACCOUNTING USE ONLY DOC TYPE DOC NUMBER DOC DATE ACCTG PRD BUDGET ACTION PO SHIP PV INT INT SELLER INT SELLER (PO or PV) 09/28/07 FY 8F.'i 2008 NEW/MOD INSTR TYPE IND FUND AGCY 7 VENDOR CODE ADDR OVERRIDE F/A INDICATOR EFT IND WXT-PO's'only(YIN) TEXT(po's only) . 60052700 REF DOC TYPE REF DOC NUMBER REF DOC LINE COM LN VEND INVOICE# COMMODITY CODE GS CONTRACT LINE FUND AGCY ORG SUB ACTV RSRC SUB FUNC OBJT SUB JOB NUMBER REP QUANTITY/ I/O DESCRIPTION AMOUNT P/F ORG RSRC OBJT CAT UNITS 1 'r11 /00 81118.5 07-352 DOCUMENT TOTAL GAX WARRANT# , „ AUDITED BY I ; PAID DATE 0 0 0 0 0 0 0 w w w w w w w tt�: c c c c c c c y 69 r 0000000 DC) 0 0 0 0 0 0 0 t -'4 o m 0 0 0 0 0 0 00 O E o O n w N m as L O pcg 'C m 0 .=CAI d m o P. ., r. m O N E 'O 'a 013, O m g,o g m m g o, c o n a m m co. U O M o, M 2,1 -, m 00 m m 9. u, Ar' a 69 69 a c D m m D.Q m< m m ? a A " wD 3L=� 1m m m rn m m m m . '. :a OmO C W pp aN B O. x m-1 Cn c�'" co Co rn O 3f m . D mmn a CO-I m J D m m D O m o a.. o m m tveS PI 3 m G N N c Q m 2 m W Hi 9 M Hi -,‘? m i.x. w N O _ O O � \° N N G C z1 3 3 m_ 5 a 'Om N , wag S d J —_mn o T Q A J T UI N C O 5 0,8 *5 SASH RECEIPT CODING MONEY FROM: Orr Prepared by/Date: "�, ,,- f .� /D //- i Please Return a Duplicate Receipt ri , 3 KS / DESCRIPTION: 4 U"7 it/d: a Ji,f41 t DESCRIPTION: 8/24/2006FORMS REVENUE ACCTING CASH RECEIPT ACCOUNT NUMBERS State of Iowa Warrant 0491-08=583-000-7000-4125 VOID' MONTHS AFTER 10 `04-07 No. 6295513,0 TO THE Treasurer of State L33-72 Des Moines, Iowa 50319 730 Pay to the order of DEPARTMENTAL REFERENCE NO'S AMOUNT WATERLOO! CITY OF 08583271006 XXXXX532?OO 7 $****81,118.55 I CLERK/AUDITOR OFFICE 583080O16O? 715 MULBERRY ST WATERLOO IA 507O3-5783Ii1JA24 ?DoF9A3oo4t4&o C3UJE K.AN SON IR DEPT.OF ADiMIN.SERVICES I. AUTHORIZED SIGNATURE 1:0 7 3000 7 2 31: 6 29551 LOH° Attach supporting to the back of this documentationform STATE OF IOWA G AX BUDGET FY PURCHASE ORDER/PAYMENT VOUCHER DOCUMENT NUMBER DATE ACCTG PERIOD(mm/yy) 200'(1 10/12/07 5G00001951 VENDOR CODE AGENCY NAME VENDOR NAME AND ADDRESS BILL TO ADDRESS(ORDERING AGENCY) SHIP TO ADDRESS WATERLOO CITY OF EMERGENCY MANAGEMENT 715 MULBERRY STPEET 7105 NW 70TH AVE WATERLOO, TA so' . j. JOHNSTON IA 50111-182 TERMS FOB ORDER APPROVED BY GOODS RECEIVED/SERVICES Phone Mcn TOWA DAI amgcrY Lorenz oct 12, 200) VENDOR'S INVOICE DATE VENDOR'S INVOICE NUMBER QUANTITY ORDERED RECEIVED UNIT OF DESCRIPTION UNIT PRICE TOTAL PRICE MEASURE 1,00 1,00 V:A PUBLIC AS121ANCE STATE SHARE 16168..220 1616e,22 WORICSHEEI ,461„ 626„611„6.7.-5,45:7;2 00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 ,00 DOCUMENT TOTAL CLAIMANT'S CERTIFICATION I CERTIFY THAT THE ITEMS FOR WHICH PAYMENT IS CLAIMED WERE FURNISHED FOR STATE AGENCY CERTIFICATION BUSINESS UNDER THE AUTHORITY OF THE LAW AND THAT THE CHARGES ARE REASONABLE, I CERTIFY THAT THE ABOVE EXPENSES WERE INCURRED AND THE AMOUNTS ARE PROPER,AND CORRECT,AND NO PART OF THIS CLAIM HAS BEEN PAID CORRECT AND SHOULD BE PAID FROM THE FUNDS APPROPRIATED BY: CLAIMANT'S SIGNATURE AUTHORIZED SIGNATURE THE FOLLOWING FIELDS ARE FOR STATE ACCOUNTING USE ONLY DOC TYPE DOC NUMBER DOC DATE ACCTG PRO BUDGET ACTION PO SHIP PV INT IND INT SELLER INT SELLER (PO or PV) FY NEW/MOD INSTR TYPEFUND AGCY 5W_C0000151 10' 12/07 E 1 7 VENDOR CODE ADDR OVERRIDE F/A INDICATOR EFT IND IEXT-13o's o?6-10nly(Y/N) TEXT(po's only) Air27,0e91i REF DOC TYPE REF DOC NUMBER REF DOC LINE COM LN VEND INVOICE If COMMODITY CODE GS CONTRACT • LINE FUND AGCY ORG SUB ACTV RSRC SUB FUNC OBJT SUB JOB NUMBER REP QUANTITY/ I/O DESCRIPTION AMOUNT I/O P/F ORG RSRC OBJT CAT UNITS 1 026') 7500 PLI 11,1U,22 07-352 DOCUMENT TOTAL GAX WARRANT# AUDITED BY -1 orenz PAID DATE