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249372 09/09/15 (9) CITY OF CARMEL, INDIANA VENDOR: 366089 ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: S*******865.48CARMEL, INDIANA 46032 PO BOX 299 CHECK NUMBER: 249372 WABASH IN 46992 CHECK DATE: 09/09/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4232100 00005407 76.00 GARAGE & MOTOR SUPPIE 1207 4231300 GT408730 451.95 DIESEL FUEL 1207 4231400 GT408730 337.53 GASOLINE (0 Z) North Central Co-op Centered on you. NCC - Hamilton County Petro ------____= PAGE 1 16222 Allisonville Road INVOICE INVOICE NO. 00005407 PO Box 1106 =_________= ORDER DATE 08/25/15 Noblesville IN 46060 ACCOUNT NO. 0000921720 317-773-0870 BATCH 403 LGB CARMEL STREET DEPT 3400 W 131ST STREET CARMEL IN 46074 -------------------------------------------------------------------------------- P.O.# SHIP DATE TERMS SLS LOC -------------------------------------------------------------------------------- MIKE 08/25/15 DUE 09/20/2015 CLD 256 ITEM NO DESCRIPTION UNITS SOLD UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 4073502 ADV HIGH TEMP GREASE - TUBES 20 EA 3 . 80000 76 . 00 TOTAL DUE $$ 76 . 00 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)) 08/25/15 00005407 $76.00 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 1106 Noblesville, IN 46060 $76.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members T 2201 I 00005407 I 42-321.001 $76.00 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 v 4ursday/jepd 5 Title Cost distribution ledger classification if claim paid motor vehicle highway fund Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester Kokomo Huntington Auburn Constantine 574-753-3673 Star City CMIMEL Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call:574-224-2667 877-615-2667 0 T) Branch Co. MI Hart MI Noblesville 517-278-4561 231-873-2158 765-675-2538 P.O.BOX 299 800-440-2667 317-773SOWO 12523 DATE 09/02/15 11:14:07 WABASH, IN 46992 COUNT: START 0.0 END 204.5 GROSS DELIVERY 204.5 GALLONS 4040 PREMIUM DX-4 off rDISTILLATI ** MULTIPLE DELIVERIES AT SITE ** SALE 7184 DATE 09/02/15 11:20:00 COUNT: START 0.0 END 136.1 GROSS DELIVERY 136.1 GALLONS 4011 87 E-10 PLUS GASOLINE 1 MULTIPLE DELIVERIES AT SITE CHARGE INVOICE Driver: GT GARY TEETERS Invoice #: GT 408730 Custooer: 0000918936 Date: 9/2/2015 BROOKSHIRE GOLF CLUB Tioe: 12:09 CITY OF CARMEL 12120 BROOKSHIRE PKWY CARMEL, IN 46033— ;Tres Teros Description Ite© # Description Legend Quantity Unit Price Itee Total 02 DUE 10/20/2015 4011 87 E-10 PLUS E 136.1000 2.30000 313.03 STATE EXCISE TAX 0.18000 24.50 02 DUE 10/20/2015 4040 PREMIUM DX-4 off rd E 204.5000 2.2100 451.95 / Invoice Subtotal: 789.48 egend: =Metered, T=Taxable, *=Eniered by Hand Indiana Sales Tax On: 0.00 ..... 0.00 Invoice Total: 789.48 RNING - 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!!! Custooer Signature: lr� USTOMER ' 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)) 09/02/15 GT 408730 Gas $337.53 09/02/15 GT 408730 Fuel $451.95 1 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 $789.48 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1207 I GT 408730 I 42-314.00 I $337.53 1 hereby certify that the attached invoice(s), or 1207 I GT 408730 I 42-313.00 I $451.95 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 Thursday, September 03, 2015 �/'_ Director, Brookshire G lub Title Cost distribution ledger classification if claim paid motor vehicle highway fund