244961 05/05/15 r C��q
G%.. CITY OF CARMEL, INDIANA VENDOR: 366089
I; ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $"""'856.77"
:.. ,?�: CARMEL, INDIANA 46032 PO BOX 299 CHECK NUMBER: 244961
�.y';�ioN� ' WABASH IN 46992 CHECK DATE: 05/05/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231300 407783 856.77 DIESEL FUEL
Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
p b Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-05,90 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
(DoBranch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-675-2538
P.O. Box 299 800-440-2667 317-7736P011888 DATE 04/22/15 08:339:06
WABASH, IN 46992 COUNTd START 0.0 END 300.2
GROSS DELIVERY 300.2 GALLONS
4049 PREMIUM DX-4 on rdDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: 6T GARY TEETERS
Customer: 0000921744 Invoice #: GT 407783
CARMEL FIRE DEPT Date: 4/22/2015
2 CIVIC SQUARE Time: 09:40
CARMEL, IN 46032
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
_02 -DUE-,05/20/2015 _ 4049 __ ___ PREMIUM-DX-4_on rd—__E__ 300,2000-- - 2.45000— --735.-49-- — --------
FEDERAL EXCISE TAX 0.24400 73.25
STATE EXCISE TAX 0.16000 48.03
Legend: Invoice Subtotal: 856.77
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 856.77
Station 41 New Generator
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHEMTREC AT I-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CUSTOMER
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-Op
IN SUM OF$
PO Box 299
Wabash, IN 46992-0299
$856.77
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 407783 42-313.00 $856.77 1 hereby certify that the attached invoice(s), or �!
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
MAY 2015
c,
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc.
Payee
Purchase Order No.
i
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
i 407783 Fill Sta.41 Generator $856.77
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