249012 08/26/15 os c�HM
>` CITY OF CARMEL, INDIANA VENDOR: 353874
ONE CIVIC SQUARE ROGERS & CO OF INDIANA, INC CHECK AMOUNT: $**-*'373.02`
CARMEL, INDIANA 46032 6364 WESTFIELD BLVD CHECK NUMBER: 249012
INDIANAPOLIS IN 46220 CHECK DATE: 08/26/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 12681 373.02 REPAIR PARTS
6364 O INDIANAPOLIS,IN 220 ®of Indiana,Inc. THIS SLICUSTOMP MUST ORMPANY INVOICE NO. V
PHONE:(317)255-3171 www.rogerspools.net ALL CLAIMS AND RETURNED GOODS
S A,,. - ./ DO,/ S NAME
ADDRESS
D 3 P�{do Gc�. t 3t S-�
O r a /�, ,►; 1• �t/ )7 V T CITY STATE
s- J`i "((pV 1 O
r
DATE SALESPERSON ❑CASH ❑C.O.D IA ❑Ppd TERMS CUSTOMER
ORDER NO.
kHARGE ❑RETD.MDSE. k ❑Coll.DEPT. F.O.B.
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❑CREDIT CARD
QUANTITY DESCRIPTION PRICE AMOUNT
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.(� � � Z t ✓ S hen C7 .
3730,2-,
SALES TAX
R IVED BY TOTAL $ 373 O2
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))
08/12/15 12681 $373.02
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
Rogers and Company of Indiana
IN SUM OF $
6364 Westfield Blvd.
Indianapolis, In 46220
$373.02
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 I 12681 I 42-370.001 $373.02 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
Th .sday, t 2 , 15
e TT17T1fI5SFn%rr
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund