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<br />DETACH BEFORE DEPOSITING <br /> <br />No. 3021734 <br /> <br />INVOICE <br /> <br />DATE <br /> <br />NUMBER <br /> <br />DISCOUNT <br /> <br />AMOUNT <br /> <br />06052008 <br /> <br />PERMIT060508 <br /> <br />0.00 <br /> <br />125.00 <br /> <br /> <br />/Il,u"# <br />~/} <br />tf' d& <br />0/ <br />r \ D ~~ <br />~,~ <br /> <br />056313 <br /> <br />0.00 <br /> <br />125.00 <br /> <br />Jun 05 08,02:25p <br /> <br />SG <br /> <br />813-313-1606 <br /> <br />p. 1 <br /> <br />-tqCD <br /> <br />~ <br /> <br />Simplex Grinnell LP <br />50 Technology Drive <br />Westminster. MA 01441 <br />(97B) 731-2500 <br />AP FAX: (978) 731-7756 <br /> <br />Fire & <br />Security <br /> <br />SinrplexG,.;nnell <br /> <br />Payment Requisition Form <br /> <br />This form is to be used.Q!l!ywhen payment is required and an invoice is..JJQt available ( Le. permits. drawings. bids). If an invoice is <br />available please go through the standard payment procedures for submitting invoices to accounts payable. <br /> <br />Please provide a detailed reason for payment and attach any available back up when submitting request. <br /> <br />Please supply vendor number. If not available, send an email tosg.apinquiry@tycoint.com. Please fill in "Request for vendor number" in <br />the subject line. Reference the full remit-to address in the body of the email, You will receive either a response with the current vendor <br />number or information on how to have the new vendor setup, <br /> <br />This payment will be made per system payment terms, Exceptions will require additional approval. (RM < $25k or VP > $25k) <br /> <br />Note: Signature cards must be on file with Accounts Payable for all approvers stating their approved dollar limit. <br /> <br />Payment Amount: <br /> <br />$125.00 <br /> <br /> Cost Distribution <br />.... PO Num $Amt <br />Q) <br />'E #1 1/ <br />0 <br />Q) #2 <br />11l <br />ttJ #3 <br />.c <br />2 #4 <br />:::l <br />a. #5 <br /> Subtotal $ - <br />Ul Proj Num Ctrl Dist $Amt <br />0 #1 <br />() <br />.a #2 <br />0 <br />-, #3 <br />t5 <br />Q) #4 <br />.... <br />is #5 <br /> Subtotal $ - <br />0. Acct Num Dept Dist $Amt <br />x #1 62471 652 292 $ 125.00 <br />W <br />-c #2 <br />ttJ <br />Q) #3 <br />-E <br />m ~. <br /> <br />Request Date: <br /> <br />06/05/08 <br /> <br />Requestor: <br />Email Address: <br /> <br />Chris Brackett <br />cbrackett@simplexqrinnell <br /> <br />Vendor Number: <br /> <br />056313 <br /> <br />Pay-to Vendor Name: <br />Remit-to Address Line 1 : <br />Remit-to Address Line 2: <br />City / State / Zip: <br /> <br />City of Zephyrhills <br />5335 8th Street <br /> <br />Zephyrhills, fI 33542 <br /> <br />Need by Date: 06/10/08 <br /> <br />ChecKs wlll be cut on Tuesdays & Thursdays <br />Reason for Pa ment: <br />Permits for sprinkler inspections at Chili's, Florida Hospital Zephyrhills, Sun Medical <br />Center, and Zephyrhills Health and Rehab in Zephyrhills, FL. <br />