243776 03/31/15 `�'�.a,q,,0 CITY OF CARMEL, INDIANA VENDOR: 366089
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ONE CIVIC SQUARE NORTH CENTRAL CO-OP -CHECK AMOUNT: $*..****408.51*
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CARMEL, INDIANA 46032 WABOX 299 BASH N asssz CHECK NUMBER: 243776
(roN CHECK DATE: 03/31/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231300 GT407604 408.51 DIESEL FUEL
NORTHWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Czm�� Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call:tt�� 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
COD V �5" Branch Co. MI Hart MI Noble AyI� 877-615-2667
517-278-4561 231-873-2158 765-67 MAB 11754 DATE 03/24/15 15:03:18
P.O.BOX 299 800-440-2667 317-77�- v START 0.0 END 151.3
WABASH,IN 46992 GC�O S DELIVERY 151.3 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
MULTIPLE DELIVERIES AT SITE
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CASH INVOICE
Driver: GT GARY TEETERS
Customer: 0000921720 Invoice #: GT 407604
CARMEL STREET DEPT Date: 3/24/2015
3400 W 131ST STREET Time: 16:05
CARMEL, IN 46074
Trns Terns Description Item # Description Legend Quantity Unit Price Item Total
01 Cash 4040 SUPER DX-4 BIODIESEL E 151.3000 2.70000 408.51
Legend: Invoice Subtotal: 408.51
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 408.51
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature: ���l�l��l l" ,�� T7.�'�i� �
CUSTOMER
VOUCHER NO. WARRANT NO.
North Central Co-op ALLOWED 20
IN SUM OF$
P.q. Box 44G6-meq
via)" IN 4@QW y(q'?
Z— I
$408.51
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 GT 407604 42-313.00 $408.51 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
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materials or services itemized thereon for
which charge is made were ordered and
received except
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T 15
reeee� ommisstoner
vCommissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund j
I
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))
03/24/15 GT 407604 $408.51
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r
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