250223 10/07/1 5f
t� _ CITY OF CARMEL, INDIANA VENDOR: 358385
® i;' ONE CIVIC SQUARE GENERAL SHALE & BRICK CHECK AMOUNT: $ ..."'213.75*
i° CARMEL, INDIANA 46032 PO BOX 5825 CHECK NUMBER: 250223
�;,,@_oN�.` CAROL STREAM IL 60197-5825 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236200 182326974 213.75 CEMENT
0010
General Shale
Building The American Dream
n o .
Invoice: 182326974 Invoice Date: 09/17/2015
Bill To: 279670 Customer P0: INLETS
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 172570121
WESTFIELD IN 46074-8267 Goods Issue Date: 09/17/2015
Order: 319257196
Sales Rep: 399
Ship-To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074-8267 Phone: 317-846-2566
— -
Mode-of Shipment: Customer Pickup / G57
Material Material Description Quantity Price Value USD
Batch Number and Description
6099001046 ESSROC BRIXMENT GRAY TYPE N 25 BAG 8.55 213.75
Subtotal 213.75
TAX
TOTAL 213.75
LATE PAYMENT CHARGE of 1.5% PER MONTH.
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))
09/17/15 182326974 $213.75
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
General Shale and Brick
IN SUM OF $
P. O. Box 5825
Carol Stream, IL 60197-5825
$213.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 182326974 I 42-362.001 $213.75 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
L .4 A I
` Thur y, �t :)er 0
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§t G, Ara'9 Pjr
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund