252067 12/02/15 y CITY OF CARMEL, INDIANA VENDOR: 366089
ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $*******762.52*
CARMEL, INDIANA 46032 PO BOX 299 CHECK NUMBER: 252067
WABASH IN 46992 CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231300 GT409305 762.52 DIESEL FUEL
North CentralCo-op
A P.O. BOX 299 - WABASH IN 46992
SALE 12914 DATE 11/20/15 10:01:55
COUNT: START 0.0 END 326.7
Centered on you. GROSS DELIVERY 326.7 GALLONS
4040 PREMIUM DX-4 off rDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: 6T GARY TEETERS
Customer: 0000921720 Invoice #: GT 409305
CARMEL STREET DEPT Date: 11/20/2015
3400 W 131ST STREET Tiae: 09:55
CARMEL, IN 46074
Tris Teres Description Ite® # Description Legend Quantity Unit Price Item Total
02 DUE 12/20/2015 4040 PREMIUM DX-4 off rd E 228.7000 2.25000 514.58
02 DUE 12/20/2015 4033 HEATING DYED E 98.0000 2.53000 247.94
Legend: Invoice Subtotal: 762.52
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 762.52
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. 6A5OLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSE
S. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9300 WE APPRECIATE YOUR BUSINESS!!!
Customer Signature: C/k
i
Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
877-615-2667
Branch Co. MI Hart MI Noblesville
517-278-4561 231-873-2158 855-773-0870
800-942-6765 888-591-8211 317-773-0870
CUSTOMER
i
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF$
P.O. Box 1106
Noblesville, IN 46060
$762.52
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I GT 409305 I 42-313.00 I $762.52 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
Ua"6 I
Frid Ab e ber 20, 2 15
Street CorriMISSIOnor
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
11/20/15 GT 409305 $762.52
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