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CITY OF CARMEL, INDIANA VENDOR: 366089
ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECKAMOUNT: $*******739.54*
CARMEL, INDIANA 46032 PO BOX 299 CHECK NUMBER: 233553
WABASH IN 46992 CHECK DATE: 06/11/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231400 GT405498 739.54 GASOLINE
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Kokomo Huntington
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Call 800-720-550 Call: 800-234-0573 800-807 3673 Call: 574-214-2667
(Coo 0 T Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-67,0ALE3610160 DATE @5/04/14 14:59:28
P.O. BOX 299 800-440-2667 317-77C U Tb START 0.0 END 869.5
WABASH, IN 46992 GROSS DELIVERY 269.8 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
* MULTIPLE DELIVERIES AT SITE ##
SALE 5521 DATE 06/04/14 15:01:338
COUNT: START 0.0 END 209.5
GROSS DELIVERY 209.5 GALLONS
4011 87 E-10 PLUS GASOLINE 1
# MULTIPLE DELIVERIES AT SITE ##
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice #: GT 405498
BROOKSHIRE GOLF CLUB Date: 6/4/2014
CITY OF CARMEL Time: 16:06
! 12120 BROOKSHIRE PKWY
I CARMEL, IN 46033—
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4011 87 E-10 PLUS E 209.5000 33.35000 701.83
State Road Tax 0.18000 37.71
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 269.1000 3.47000 933.78
Legend: Invoice Subtotal: 1,673.32
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 1,673.32
WARNING — PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-4224-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CLJSTOMErlo-�
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF$
P.O. Box 299
Wabash, IN 46992
$1,673.32
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 GT 405498 42-313.00 $933.78 1 hereby certify that the attached invoice(s), or
1207 GT 405498 42-314.00 $739.54 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
} Friday, June 06, 2014
Director, BroQhire Golf Club
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))
06/04/14 GT 405498 Diesel Fuel $933.78
06/04/14 GT 405498 Gas $739.54
1 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