251624 11/18/15 �..c�qy
f� CITY OF CARMEL, INDIANA VENDOR: 176650
® a ONE CIVIC SQUARE WORSEN ENVIRONMENTAL SERVICES CHECK AMOUNT: $....*"333.25'
}. ? CARMEL, INDIANA 46032 2719 N ARLINGTON AVE CHECK NUMBER: 251624
•.y�,TON�o, INDIANAPOLIS IN 46218-3300 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350100 038799 333.25 BUILDING REPAIRS & MA
Koorsen®R www.KoorsenES.com
ENVIRONMENTAL SERVICES INVOICE
REMIT TO: Koorsen Environmental Services 0 3 8 7 9 9 Date of 11/0 3/2 015 Order
N o.: Wok: #.
2719 N Arlington Avenue
Indianapolis,IN 46218-3322 Invoice Date: 11/04/2015 SO#: 133307 Date 11/29/2015
317-308-7676 Include invoice#on check. Due:
Cust ID 51BRO1212 TEa,MS: NET 25 DAYS JOB# SERVICE51 / 0
Sold To: Location:
CITY OF CARMEL CITY OF CARMEL
d/b/a BROOKSHIRE GOLF CLUB 12120 BROOKSHIRE PKWY
12120 BROOKSHIRE PARKWAY D/B/A BROOKSHIRE GOLF CLUB
CARMEL, IN 46033 CARMEL, IN 46032
51-HOUSE / 51-000077 / STOCK
AMOUNT.
NOVEMBER EXHAUST CLEANING/SVC Semi-Annual
1. 00 CLEAN-EXHAUST CLEANING,KITCHEN EXHAUST 318 .25 318 .25
1.00 99STCK2 SERVICE CALL KITCHEN SERVICE II 15.00 15.00
TOTAL SALES/SERVICES XMP# 0031201550-020 333 .25
TOTAL 333 .25
To pay by credit card, please phone or return to us:
Circle:VISA MC AMEX Card Number — — —
Name on Card Expiration Date—/—
Total Sales Taxable Sales Tax Amount Shipping Charge Invoice Total
333.25 0.00 0.00 333.25
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))
11/04/15 038799 Vent Cleaning $333.25
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
Koorsen Environmental Services
IN SUM OF $
2719 N Arlington Avenue
Indianapolis, Indiana 46218-3322
$333.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 038799 ( 43-501.00 I $333.25 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
Monday, November 16, 2015
/A
�J
Director, Br kshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund