253034 01/11/16 0v,qM�• CITY OF CARMEL, INDIANA VENDOR: 355029
ONE CIVIC SQUARE DIRTWORKS LLC
\. CHECK AMOUNT: $*******550.00*
:. ?� CARMEL, INDIANA 46032 5925 E 122ND STREET CHECK NUMBER: 253034
•M,�TON moo, CARMEL IN 46033 CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 15438 550.00 OTHER EXPENSES
Dirtworks, LLC
5925 East 122nd Street Invoice
Carmel, M 46033
Phone # (317)428-8210 Fax# (317)846-0338 `Date,_-� 111VOICe #
12/31/2015 15438
Blll'To
City of Carmel Utilities
3450 West 131st Street
Westfield,IN.46074
Due Date
2/1/2016
Date ' Description Qty Rate Amount
12/2/2015 Ticket#704962,Shop 1 20.00 20.00
12/3/2015 Ticket 4208270,Shop by#117 1 20.00 20.00
12/4/2015 Ticket#208372,Shop by#211 1 30.00 30.00
Same by#145 5 20.00 I00.00
Same by#72 5 20.00 100.00
Same by#70 4 20.00 80.00
Ticket#707831,Water Dept by#211 1 30.00 30.00
12/8/2015 Ticket#302299,Street Dept by#C22 1 50.00 50.00
12/18/2015 Ticket#852179,Shop by#145 3 20.00 60.00
Same by 970 3 20.00 60.00
tel!
-If Your Account is 60 Days Past Due-----Your Account Will be Closed until
Payment Is Received! Total $550.00
Balance Due $550.00
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
3555029
DIRTWORKS LLC Purchase Order No.
5925 EAST 122ND STREET Terms
CARMEL, IN 46033 Due Date 12/30/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/30/201: 15438 $550.00
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
Date Officer
VOUCHER # 153924 WARRANT# ALLOWED
3555029 IN SUM OF $
DIRTWORKS LLC
5925 EAST 122ND STREET
CARMEL, IN 46033
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR I
t
Board members
PO# INV# ACCT# AMOUNT i' Audit Trail Code
15438 01-6360-06 $550.00
I
t
I
I
�1
Voucher Total $550.00
Cost distribution ledger classification if
claim paid under vehicle highway fund