240764 1 /10/2015 CITY OF CARMEL, INDIANA VENDOR: 366089
® ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: S*******714.12*
CARMEL, INDIANA 46032 Po Box 299 CHECK NUMBER: 240764
WABASH IN 46992 CHECK DATE: 01/07/15
SON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231300 GT407037 477.40 DIESEL FUEL
2201 4231500 GT407037 236.72 OIL
HammWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Cmnp Kokomo Huntington Auburn Constantine 574-753-3673 Star City
ku Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
cal-OT) Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-67%3811317 DATE 12/19/14 09:49:26
P.O.BOX 299 800-440-2667 317-77
WABASH, IN as992 7.0
START 0.0 END 215.1
GROSS DELIVERY 215.1 GALLONS
4040 SUPER DX-4 BIDDIESDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921720 Invoice #: GT 407037
CARMEL STREET DEPT Date: 12/19/2014
3400 W 131ST STREET Time: 09:50
CARMEL, IN 46074
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 DUE 01/20/2015 4040 SUPER DX-4 BIODIESEL E 150.6000 3.17M 477.40
02 DUE 01/20/2015 4031 Oil E 64.5000 3.67000 236.72
Legend: Invoice Subtotal: 714.12
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 714.12
DARNING — 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 1-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature:
I
3I'S - *4140
CUSTOMER
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))
12/31/14 GT 407037 $236.72
12/31/14 GT 407037 $477.40
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P.O. Box 49ffi 2-99
$714.12
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 GT 407037 42-315.00 $236.72 1 hereby certify that the attached invoice(s), or
2201 GT 407037 42-313.00 $477.40 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
dnesda r er 4, 1
Street Commissioner
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund