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304543 10/31/16
.'4�'C,pff CITY OF CARMEL, INDIANA VENDOR: 355029 tib ONE CIVIC SQUARE DIRTWORKS LLC CHECK AMOUNT: $*******230.00* _� CARMEL, INDIANA 46032 5925 E 122ND STREET CHECK NUMBER: 304543 M�«ON,CO, CARMEL IN 46033 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 17153 230.00 OTHER EXPENSES VOUCHER # 162963 WARRANT# ALLOWED 3555029 IN SUM OF $ DIRTWORKS LLC 5925 EAST 122ND STREET CARMEL, IN 46033 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 17153 01-6360-06 230.00 Voucher Total 230.00 Cost distribution ledger classification if claim paid under 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 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 10/6/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/6/2016 17153 230.00 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 Dirtworks, LLC Invoice 5925 East 122nd Street Carmel, IN 46033 Phone # (317)428-8210 Fax # (317)846-0338 F�D49I11V01Ce 9/30/2016 17153 ti 1 i' J 1 1 Y r 1 3 Blil'To City of Carmel Utilities 3450 West 131st Street Westfield,IN.46074 D'ue Date`' 11/1/2016 Date , Description' Qty Rate Amount- 9/1/2016 Ticket#426359,Shop by#212 3 30.00 90.00 9/12/2016 Ticket#431254,Shop by#72 2 20.00 40.00 Same by#70 1 20.00 20.00 9/29/2016 Ticket#059096,Carmel Station by#72 2 20.00 40.00 Same by#70 2 20.00 40.00 -If Your Account is 60 Days Past Due-----Your Account Will be Closed until Payment Is Received! Total $230.00 Balance Due $230.00 N O . cn O - N UD C}irtwoiks tl'C 35 j � �. ?•42&62�0 Or 3:7 4=''3 32!8 25 4 Far WRARMM 0 Ln r L��@-i�rASHjI ".fit - t;,•:�i`•"i.�i;F.SE.�=iO.- •a_.-� }' � - �M 1 c I �- Q4Atl. CESCri1PTTflti �T} A'r,GihT co zo - - .---- � W — -- + 12 ,ED c KEEP T HIS SLIP FOR REFEREUCE - N C7 Ol i �D Dirtworks LLC 3t7.42MIQ or W-o28.82t19 �.aa:3t7$45�033$ G'.($7tamEwS oFea w. 11 DATE i D 0,141 i' ~ a � �.o� Ess �r- PIZ n I-LD B: CASH.. Ub.13.'CkARGE;Pjtt.ACC.T.17ADSE.REMI PARD OUr lii3krf. cl5WRIPTION Ld A t a v 3 v d 5 w � ' w 0 7 w- 8 4 9 t1 �z RECEM BY ..M M KEEP THIS SUP FOR REFEREKCE w Q OY i O �D Q LJ Dirt W UC 317-CMI O or .1174 426359 �), 2 6 3 5 9 Fac 317-846033838 0 ri351'4!dER'S ORDER NO. PATE NAMELek Au'DR:SS n C(-Y.STA71m.?Pui �.1 . rn _t�UA'�,I��• TIES;r!PT�Cfi:� r A!41©MT W CD NJ W. E � B� !0 S2 ' REQ:NED BY T , KEEP THIS SLIP FOR REFERENCE „