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Home My WebLink About301423 07/28/16 GAA CITY OF CARMEL, INDIANA VENDOR: 36089 J�3 ONE CIVIC SQUARE N RTH CENTRAL CO-OP CHECK AMOUNT: $**...**782 77* CARMEL, INDIANA 46032P0 BOX 299 CHECK NUMBER: 301423 w BASH IN 46992 CHECK DATE: 07/28/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4231300 GT410884 433.40 DIESEL FUEL 1207 4231400 GT41088 349.37 GASOLINE VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) NORTH CENTRAL CO-OP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 299 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service WABASH, IN 46992 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $349.37 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Brookshire Golf Course Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT GT 410884 42-314.00 $349.37 1 hereby certify that the attached invoice(s),or 7/18/16 GT 410884 Fuel $349.37 1207 101 1207 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for h-charge-is-made-were-ordered-and received except Tuesday,July 26,2016 hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 ,20— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995) NORTH CENTRAL CO-OP ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 299 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service WABASH, IN 46992 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $433.40 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Course Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT GT 410884 42-313.00 $433.40 1 hereby certify that the attached invoice(s),or 7/18/16 GT 410884 Diesel $433.40 1207 101 1207 101 bill(s)is(are)true and correct and that the materials or services itemized thereon for which-charge-is-made-were_o.rdered and received except Tuesday,July 26,2016 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer North Central Co-op P.O. BOX 299 ® W BASH 4 2 , IN 699 SALE 14055 DATE 07/18/16 10:44:53 COUNT: START 0.0 END 818.0 Centered on you. GROSS DELIVERY 818.0 GALLONS 4040 PREMIUM DX-4 off rDISTILLATI MULTIPLE DELIVERIES AT SITE SALE 8246 DATE 07/18/16 10:53:21 COUNT: START 0.0 END 161.0 GROSS DELIVERY 161.0 GALLONS 4011 87 E-10 PLUS GASOLINE 1 # MULTIPLE DELIVERIES AT SITE CHAR69 INVOICE Driver: GT GARY TEETERS Customer: 0000918936 Invoice #: GT 410884 BROOKSHIRE GOLF CLUB Date: 7/18/8016 CITY OF CARMEL Time: 11:35 12180 BROOKSHIRE PKWY CARMEL, IN 46033- Tres Terms Description Iter # Description Legend Quantity Unit Price Item Total 02 DUE 08/20/2016 4011 87 E-10 PLUS * 161.0000 1.99000 320.39 - STATE EXCISE TA 0.18000 28.98 02 DUE 08/20/2016 4040 PREMIUM DX-4 ofi rd 197.9000 2.19000 433.40 Legend: Invoice Subtotal: 782.77 E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00 Invoice Total: 782.77 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 CHEMTREC AT 1-800424-9300 WE APPRECIATE YOUR BUSINESS!!! Customer Signa ure: 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