230643 03/26/14 y CITY OF CARMEL, INDIANA VENDOR: 368091
d l ONE CIVIC SQUARE TOTAL RESTORATION CHECK AMOUNT: $****21,310.03*
CARMEL, INDIANA 46032 7002 BROOKVILLE ROAD CHECK NUMBER: 230643
INDIANAPOLIS IN 46239 CHECK DATE: 03/26/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 2804 21,310.03 BUILDING REPAIRS & MA
j�l I
c
7002 Brookville Rd. Indianapolis, IN 1 Zo Invoice
46239 Tax Id 27-2092149
317-351-0555 317-351-0595(fax)
RESTORATION; Toll Free 800-962-1719 D. - •
1/16/2014 2804
City of Carmel
ATTN: Steve Engelking
1 Civic Square
Carmel, IN 46032
Rep Due Date Adjuster Name Claim Number
CM Due on receipt N. Brim EZQ0479
Emergency Services for 918 South Rangeline Road 20,910.03
Plumbing Repair 400 00
Submitted To
MAR 2 4 2014
Clerk T reasurer
Please send check to above address once you have received from Insurance company.Thank You! Total
$21,310.03
Payments/Credits
$0.00
WSA r L AMERICAN DISCOVER
Balance Du 21,310.03
VOUCHER NO. WARRANT NO.
ALLOWED 20
Total Restoration
IN SUM OF $
7002.Brookville Rd
Indianapolis, IN 46239
$21,310.03
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
_ Board Members
1205 I 2804 I 43-501.00 I $21,310.03 I 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
Monday, March 24, 2014
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
01/16/14 2804 $21,310.03
I 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