249248 09/09/15 � CSF.
''` MfI CITY OF CARMEL, INDIANA VENDOR: 363940
G�
® = ONE CIVIC SQUARE FILTER SERVICES OF INDIANA CHECK AMOUNT: $**....*258.52*
CARMEL, INDIANA 46032 1550 INDIANA AVE CHECK NUMBER: 249248
+'"roe�, INDIANAPOLIS IN 46202-2153 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 20150827 258.52 OTHER EXPENSES
Date Invoice# S.O. No.
> ]FILTER 1550 Indiana Ave.
K SERVICES Indianapolis, IN 46202-2153 8/7/2015 20150827
)OF INDIANA Phone# (317) 264-2123
✓`� Fax#(317) 264-2121
P.O. No. S15355
Bill To Ship To
CITY OF CARMEL WATER POLLUTION CITY OF CARMEL WATER POLLUTION CONTROL
CONTROL FACILITY & SEWER DEPT.
FACILITY & SEWER DEPT. 9609 HAZEL DELL PARKWAY
9609 HAZEL DELL PARKWAY INDIANAPOLIS, IN 46280
INDIANAPOLIS, IN 46280
Terms Due Date Ship Date Ship Via FOB Rep Project
Net 30 Days' 9/612015 8i7/2015
Item Description Ordered Prev. Inv. Invoiced Rate Amount
ZLP 16x80 ... 054162004 ZLP 16x80 LINKED RING 0 13.21 1.'0.00
PANELS- 3 PLY -.
20X25X2 M... 102-700-021 20X25X2 Multi-Pleat M8 36 -3.33 - 119:88
20X2OX2 M... 102-700-019 20X2OX2 Multi-Pleat M8__ 24 3.08 73.92
16X25X4 M....--102=700-026-16X25X4 Multi-Pleat M8 6 6.62 39.72
Delivery Ch...i Delivery Charge 1 25.00 25.00
i
n
:Subtotal, t $258-52-w
Sales Tax (7.0%) $0.00
rs
Total $258.52
Payments/Credits $0.00
Balance Due $258.52
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
363940
FILTER SERVICES OF INDIANA Purchase Order No.
1550 INDIANA AVE. Terms
INDIANAPOLIS, IN 46202-2153 Due Date 9/1/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/1/2015 20150827 $258.52
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
Date Officer
VOUCHER # 156212 WARRANT # ALLOWED
363940 IN SUM OF $
FILTER SERVICES OF INDIANA
1550 INDIANA AVE.
INDIANAPOLIS, IN 46202-2153
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
20150827 01-7202-06 $258.52
Voucher Total $258.52
Cost distribution ledger classification if
claim paid under vehicle highway fund