251665 11/18/15 ^.+f - CITY OF CARMEL, INDIANA VENDOR: 366089
® ! ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $*******784.81'
�. ?� CARMEL, INDIANA 46032 PO Box 299 CHECK NUMBER: 251665
�MiTON�` WABASH IN 46992 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT409189 334.81 DIESEL FUEL
1207 4231400 GT409189 450.00 GASOLINE
Norte Central C
P.O.
.O. OX 299 WABASH, IN 46992
SALE 7402 DATE 11/05/15 09:42:34
COUNT: START 0.0 END 200.0
GROSS DELIVERY 200.0 GALLONS
Centered on you. 4011 87 E-10 PLUS GASOLINE 1
** MULTIPLE DELIVERIES AT SITE
SALE 128533 DATE 11/05/15 09:36:03
COUNT: START 0.0 END 136.1
GROSS DELIVERY 136.1 GALLONS
4040 PREMIUM DX-4 off rDISTILLATI
** MULTIPLE DELIVERIES AT SITE J
I
CHARGE INVOICE
Driver: GT GARY TEETERS
Custoner: 0000918936 Invoice #: GT 409189
BROOKSHIRE GOLF CLUB Date: 11/5/2015
CITY OF CARMEL Tice: 09:30
12120 BROOKSHIRE PKWY
CARMEL, IN 46033-
Tr®s Teras Description Iteo # Description Legend Quantity Unit Price Ite® Total
02 DUE 12/20/2015 4011 87 E-10 PLUS E 200.0000 2.07000 414.00
STATE EXCISE TAX 0.18000 36.00
02 DUE 12/20/2015 4040 PREMIUM DX-4 off rd E 136.1M 2.46M 334.81
Legend: Invoice Subtotal: 784.81
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
I Invoice Total: 784.81
I
WARNING - 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 CHENTREC AT 1-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Custoser Signature:
Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City I,
Call:800-720-0550 Call: 800-234-0573 800-807-3673 Call:574-224-2667
Branch Co.MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 855-773-0870
800-942-6765 888-591-8211 317-773-0870 CUSTOMER
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))
11/05/15 GT 409189 Gas $450.00
11/05/15 GT 409189 Diesel $334.81
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 299
Wabash, IN 46992
$784.81
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1207 GT 409189 42-314.00 $450.00 1 hereby certify that the attached invoice(s), or
1207 GT 409189 42-313.00 $334.81 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 09, 2015
Director, Brookshire If Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund