249406 09/09/15 �C.1q .
�il��. "'- CITY OF CARMEL, INDIANA VENDOR: 356009
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® a - ONE CIVIC SQUARE R G A/HOOSIER RUBBER &TRANSMISSVMCK AMOUNT: $.....'"19.20'
,_ CARMEL, INDIANA 46032 3905 EAST PROGRESS STREET CHECK NUMBER: 249406
�.y`�...,�o. NORTH LITTLE ROCK AR 72114 CHECK DATE: 09/09/15
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 674027001 19.20 OTHER EXPENSES
INVOICE
MAIL REMITTANCE TO: ENTERING OFFICE IN VOICE NUMBER IRAN
CODE
RGA G74027-001 DI
RGA
2002 LAFAYETTE RD. INVOICE DATE PAGE
INDIANAPOLIS IN 46222 08/20/15 1
AN EMPLOYEE OWNED COMPANY
3905 East Progress Street
Any different or additional terms that may be embodied in your purchase order are hereby objected to. If your order is not an
North Little Rock, AR 72114 acceptance of our proposal,this will operate as an acceptance of your order only In the event you agree to the terms hereof.
The terms and conditions contained above and attached shall apply.
pAiH ::EtUMBER:::::......::::::. Ui�tlf.01,MEASL3EtE:< UREE7.E?EZE.CE::i:i>;;::::;': EXTNDES;::::
TOTAL BACK.; 7HE3
NO. HDE DESCEa1PT10P[' PAL1pUCT DtSCOU1dT% AEUEOUA[f
IPM pjT:i .... ...
10 8 8 SKT1000-1/4X8 2.4000 19.20
SKIRTBOARD RBR GLBR LF
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FOLD
CUST. NO. ORDER DATE TERR PC ORD Written By DATE SHIPPED WHSE AMOUNT 19.20
TC125 08/20/15 TD 70 S TJS 08/20/15 70
FRGHT/INS/HNDL .00
Carrier: WILL CALL FOB: SP,FNA,PREPAID ORIGINAL INVOICE SALES TAX .00
Tracking:
Terms of Payment: NET 30 DAYS I INVOICE TOTAL I 19.20
Please Pay This Amount
ORDER ISSUED IN: INDIANAPOLIS
Note New Remit To Address: PHONE: 317/634-3976
3905 East Progress Street
North Little Rock, AR 7211=1
Customer PO No. S15387 Mark No.
s CARMEL UTILITIES s CARMEL WASTE WATER
0 9609,HAZELDELL PKWY H 9609 HAZEL DELL PARKWAY
T INDIANAPOLIS IN 46280 T INDIANAPOLIS IN 46280
0 0
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
350590
RGA/HOOSIER RUBBER & TRANSMISSON Purchase Order No.
3905 E. Progress Street Terms
North Little Rock, AR 72114 Due Date 8/27/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/27/2015 G74027-001 $19.20
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 # 156177 WARRANT # ALLOWED
350590 IN SUM OF $
RGA/HOOSIER RUBBER & TRANSMIS;
3905 E. Progress Street
North Little Rock, AR 72114
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
G74027-001 01-7202-06 $19.20
Voucher Total $19.20
Cost distribution ledger classification if
claim paid under vehicle highway fund
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