245930 06/03/15 �A\f( CITY OF CARMEL, INDIANA VENDOR: 366089
® Y�l ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $*****1,225.77*
x• � CARMEL, INDIANA 46032 Po sox 299 CHECK NUMBER: 245930
9M�l TON�G�. WABASH IN 46992 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231300 408060 1,225.77 DIESEL FUEL
No= Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
CW
MEL
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 1100-234-0573 800-807-3673 Cal1: 574-224-2667
�o 0 Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-675S$L-63812075 DATE 05/29/15 08:01:20
P.O. BOX 299 800-440-2667 317-773C9UNT-3- START 0.0 END 394.9
WABASH, IN 46992 GROSS DELIVERY 394.9 GALLONS
4049 PREMIUM DX-4 on rdDISTILLATI
## MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921744 Invoice #: GT 408060
CARMEL FIRE DEPT Date: 5/29/2015
2 CIVIC SQUARE Tice: 09:03
CARMEL, IN 46032
Tris Terms Description Item # Description Legend Quantity Unit Price Item Total
02 DUE 06/20/2015 4049 PREMIUM DX-4 on rd E 394.9000 2.70000 1066.23
FEDERAL EXCISE TAX 0.24400 96.36
STATE EXCISE TAX 0.16000 633.18
Legend: Invoice Subtotal: 1,225.77
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 1,225.77
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:
(OUSTOMER
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-Op
IN SUM OF$
PO Box 299
I
Wabash, IN 46992-0299
$1,225.77
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 408060 42-313.00 $1,225.77 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
11N 2015
I
1)0- A
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
rescribed by State Board of Accounts City Form.No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
hom, 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))
408060 $1,225.77
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