242707 03/03/15 CITY OF CARMEL, INDIANA VENDOR: 364677
ONE CIVIC SQUARE CLEAN EARTH SYSTEMS INC CHECK AMOUNT: $"""`1,420.00`
CARMEL, INDIANA 46032 15245 AMBERLY DRIVE CHECK NUMBER: 242707
TAMPA FL 33647 CHECK DATE: 03/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 59638 1,420.00 OTHER EXPENSES
Voice: (813) 930-6688 Invoice
Fax: (813) 930-2530 Invoice Number:
Cleantar59638
•mmmseammmmamoomaomaoaoouese�.,�,;,R Invoice Date:
S Y S T E M S, I N C.
2015
15245 AMBERLY DRIVE Feb 78, Page
Tam FL 33647-2155 Page:
pay 1
USA
Sold To: Ship to:
City of Carmel HHW City of Carmel HHW
760 3rd Avenue 901 N rangeline Load
Attn: Bill Kelam Carmel, IN 46032
Carmel, IN 46032
Customer ID Customer PO Payment Terms
CITY0019 BKELLAM021915 2% 15, Net 30 Days
Sales Rep ID Shi ping Method Ship Date Due Date
MW CH ROBINSON 2/19/15 3/20/15
Quantity Item Description Unit Price Extension
100.00H4FTUNBP ICH 4-FT U.N. Rated Bulb-Pak 10.00 1,000.00
25.00CH8FTBULB CH 8-Foot Bulb Box 12.00 300.00
Subtotal 1,300.00
Sales Tax
Freight 120.00
Total Invoice Amount 1,420.00
Check/Credit Memo No: Payment/Credit Applied
TOTAL 1,420.00
VOUCHER # 155037 WARRANT# ALLOWED
364677 IN SUM OF $
CLEAN EARTH SYSTEMS INC
15245 AMBERLY DRIVE
TAMPA, FL 33647
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
59638 01-720H-08 $1,420.00
I
I
r
Voucher Total $1,420.00
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
364677
CLEAN EARTH SYSTEMS INC Purchase Order No.
15245 AMBERLY DRIVE Terms
TAMPA, FL 33647 Due Date 2/27/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount_
i
2/27/2015 59638 $1,420.00
I!
f
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 icer