250265 10/07/1 5 '' CITY OF CARMEL, INDIANA VENDOR: 354857
® it ONE CIVIC SQUARE HOOSIER PORTABLE RESTROOMS INC CHECK AMOUNT: $..... 400.00'
s. _� CARMEL, INDIANA 46032 2201 E 99TH ST CHECK NUMBER: 250265
+y_,oN 40, INDIANAPOLIS IN 46280 CHECK DATE: 10107/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
851 5023990 11437 400.00 OTHER EXPENSES
00 License #29-031/33/35 Invoice
HOOSIER 22o1 E. 99th Street
IndtanapoCts, JTW4628o Date Invoice #
9/15/2015 11437
Bill To: Customer Phone
Carmel Fire Department 317-409-3538
Keith Freer
2 Civic Square
Carmel, IN 46032 Customer Alt. Phone
P.O. No. Terms Project
Verbal/Tim Due upon receipt, please. Carmel Safety Days
Item_-_: - -- -- Servicer Ddtes -' : . _Qua nti -_Rdte _ -
_. Amount
Standard Unit(s) Serviced - SE September 19 ,2015 4 50.00 200.00
Portable Handwashing Station St Vincent Hospital North 4 50.00 200.00
Trash Box Used 6 0.00 0.00
It is a pleasure working with you! _..,_
Total $400.00
--- --- _. - - Balance Due $400.00
Office : (317) 844-6919
Emaih hoosier_porta6Ces@gmad com VISA
Website: www.hoosierporta6Ces.coln
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))
11437 $400.00
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
Hoosier Portable Restrooms
IN SUM OF $
2201 E. 99th Street
Indianapolis, IN 46280
$400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 11437 120-851.00 $400.00 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
1� -� 'A .- I // A -
ON) )d �wlywalp
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund