240661 01/07/2015 {n+u���p":� CITY OF CARMEL, INDIANA VENDOR: 355029
f�,;
,_ b it ONE CIVIC SQUARE DIRTWORKS LLC CHECK AMOUNT: $*—...765.00'
CARMEL, INDIANA 46032 5925 E 122ND STREET CHECK NUMBER: 240661
<.;,,<<N a CARMEL IN 46033 CHECK DATE: 01/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 13088 765.00 OTHER EXPENSES
i ®rks, LLC
5925 East 122nd Street Invoice
Carmel. IN 46033
Phone # (317)428-8210 Fax # (317)846-03383te
11/30/2014 13088
B11I To
City of Carmel Utilities
3450 West 13 tst Street
Westfield, IN. 46074
;:Due:Date:"
111/2015
Date Description Qty Rate Amount
11/5/2014 Ticket#768828, Shop by#70 1 20.00 20.00
11/6/2014 Ticket#768896, Shop by#72 4 20.00 80.00
Same by#70 4 20.00 80.00
11/7/2014 Ticket#668833, Shop by#72 5 20.00 100.00
Same by#70 3 20.00 60.00
1.1/10/2014 Ticket#677551, 1st Ave&Fourth by#72 1 20.00 20.00
Same by#70 1 20.00 20.00
11/12/2014 Ticket 9683532,EQ Basin by#70 2 20.00 40.00
Same by#151 2 20.00 40.00
11/14/2014 Ticket#796970,Water Department#28 1 25.00 25.00
Ticket#796971, Shop by#145 2 20.00 40.00
Same by#70 1 20.00 20.00
11/17/2014 Ticket#563759, Shop by#70 1 20.00 20.00
11/19/2014 Ticket#565117, Job Site by#145 1 20.00 20.00
--` - Ticket#565122, t 16th&Haverstick by#70 1 20.00 20.00
Same by#72 1 20.00 20.00
11/21/2014 Ticket#161873, 1st&4th by#70 1 20.00 20.00
11/26/2014 Ticket#161095,#161073 𧔒,Plant#5 by FWS#V12 3 40.00120.00
-If Your Account is 60 Days Past Due-----Your Account Will be Closed until
Payment Is Received! Total $765.00
l� c� Due -......2
765.00
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
3555029
DIRTWORKS LLC Purchase Order No.
5925 EAST 122ND STREET Terms
CARMEL, IN 46033 Due Date 12/2/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/2/2014 13088 $765.00
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
Date Officer
VOUCHER# 142425 WARRANT # ALLOWED
3555029 IN SUM OF $
DIRTWORKS LLC
5925 EAST 122ND STREET
CARMEL, IN 46033
Carmel plater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
13088 01-6360-03 $120.00
13088 01-6360-06 $645.00
i
Voucher Total $765.00
Cost distribution ledger classification if
claim paid under vehicle highway fund