HomeMy WebLinkAbout238893 11/05/14 CITY OF CARMEL, INDIANA VENDOR: 366089
® ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $*****1,432.53*
CARMEL, INDIANA 46032 PO BOX 299 WABASH N 46992 CHECK NUMBER: 238893
„oN CHECK DATE: 11/05/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT406569 734.71 DIESEL FUEL
1207 4231400 GT406569 697.82 GASOLINE
N®. Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573
800-807-3673 Call: 574-224-2667
Branch Co. MI Hart MI Noble )+'I� 877-615-2667
517-278-4561 231-873-2158 765-67 .41 810911 DATE 10/22/14 11:24:84
P.O.Box 299 TAR 0.0 END 255.0
N START
WABASH, IN 46992 800-440.2667 317-77c��0
GROSS DELIVERY 255.0 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
* MULTIPLE DELIVERIES AT SITE
SALE 6121 DATE 10/22/14 11:27:44
COUNT: START 0.0 END 238.0
GROSS.DELIVERY 238.0 GALLONS
4011 87 E-10 PLUS with GASOLINE 1
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice R: GT 406569
BROOKSHIRE GOLF CLUB Date: 10/22/2014
CITY OF CARMEL Time: 12:27
12120 BROOKSHIRE PKWY
CARMEL, IN 46033-
Trms Terms Description Item # Description. Legend Quantity Unit Price Item Total
02 DUE 11/20/2014 4011 87 E-10 PLUS with US E 238.0000 2.75200 654.98
STATE EXCISE TAX 0.18000 42.84
02 DUE 11/20/2014 4040 SUPER DX-4 BIODIESEL- E 255.0000 3.07000 782.85
02 DUE 11/20/2014 2223 GAS USE TAX EXEMPT t J -236.0000 0.20400 -48.14
Legend: Invoice Subtotal: 1,432.53
E=Metered, T=Taxable,-*=Entered-by-Hand Indiana Sales-Tax 06: 0.00 ..... 0.00
Invoice Total: 1,432.53
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9306 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature:
_ - - M
STO E R
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF$
P.O. Box 299
Wabash, IN 46992
$1,432.53
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1207 GT 406569 42-313.00 $734.71 1 hereby certify that the attached invoice(s), or
1207 GT 406569 1 42-314.00 $697.82 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, October 31, 2014
Director, Brookshire 41f Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
n invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered,by
hom, 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))
10/22/14 GT 406569 Diesel $734.71
10/22/14 GT 406569 Fuel $697.82
hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance
ith IC 5-11-10-1.6
20
Clerk-Treasurer