246913 06/30/15 CITY OF CARMEL, INDIANA VENDOR: 366089
ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: S*****2,216.96*
CARMEL, INDIANA 46032 PO BOX 299 CHECK NUMBER: 246913
(9,
WABASH IN 46992 CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231300 GT 408175 1,041.11 DIESEL FUEL
1207 4231300 GT 408247 743.94 DIESEL FUEL
1207 4231400 GT 408247 431.91 GASOLINE
HOMEWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
I
Branch Co. MI Hart MI Noblesville 877-615-2667
P.O.BOX 299 517-278-4561 231-873-2158 765-675-2538
WABASH, IN 46992 800-440-2667 317-773SAEE?012157 DATE 06/15/15 13:36:23
COUNT: START 0.0 END 340.9
GROSS DELIVERY 340.9 GALLONS
4049 PREMIUM DX-4 on rdDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921744 Invoice #: 6T 408175
CARMEL FIRE DEPT Date: 6/15/2015
2 CIVIC SQUARE Time: 14:37 I
f CARMEL, IN 46032
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 DUE 07/20/2015 4049 PREMIUM DX-4 on rd E 340.9000 2.65000 903.39
FEDERAL EXCISE TAX 0.24400 83.18
STATE EXCISE TAX 0.16000 54.54
Legend: Invoice Subtotal: 1,041.11
E=Metered, T=Taxable, *centered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 1,041.11
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASQLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature:
I "
Cl��'.STOMER
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))
408175 $1,041.11
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-Op
IN SUM OF $
PO Box 299
Wabash, IN 46992-0299
$1,041.11
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 408175 42-313.00 $1,041.11 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
JUN 2 9 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Cmq
mm
a Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
CC-01T) Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-675-2538
P.O. BOX 299 800-440-2667 317-7735PN012M DATE 06/25/15 11:03:09
WABASH, IN 46992
COUNT: START 0.0 END 290.6
GROSS DELIVERY 290.6 GALLONS
4040 PREMIUM DX-4 off rDISTILLATI
*t MULTIPLE DELIVERIES AT SITE
SALE 6917 DATE 06/25/15 11:09:14
COUNT: START 0.0 END 163.6
GROSS DELIVERY 163.6 GALLONS
4011 87 E-10 PLUS GASOLINE 1
MULTIPLE DELIVERIES AT SITE II
I
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice #: GT 408247
BROOKSHIRE GOLF CLUB Date: 6/25/2015
CITY OF CARMEL Time: 12:05
12120 BROOKSHIRE PKWY
CARMEL, IN 46033-
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 DUE 07/20/2015 4011 87 E-10 PLUS E 163.6000 2.46000 402.46
STATE EXCISE TAX 0.18000 29.45
02 DUE 67/20/2015 4040 PREMIUM DX-4 off rd E 290.6000 2.56M 743.94
Legend: Invoice Subtotal: 1,175.85
E=Metered, T=Taxable, *centered by Hand Indiana Sales Tax On: 0.00 ..... 0.00 i
Invoice Total: 1,175.85
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:
I
(OUSTOMEFI��'�
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))
06/25/15 I GT 408247 I Fuel $431.91
06/25/15 I GT 408247 Diesel $743.94
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 299
Wabash, IN 46992
$1,175.85
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 GT 408247 I 42-314.00 I $431.91 1 hereby certify that the attached invoice(s), or
1207 I GT 408247 I 42-313.00 I $743.94 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
Monday, June 29, 2015
Director, Broo shi Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund