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308183 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 178002 ® ONE CIVIC SQUARE KROGER CO CHECK AMOUNT: $**"***134.09` CARMEL, INDIANA 46032 CENTRAL CUSTOMER CHARGES CHECK NUMBER: 308183 PO Box 644467 CHECK DATE: 02/13/17 PITTSBURG PA 15264-4467 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4343003 A03849 134.09 TRAVEL & LODGING VOUCHER NO. WARRANT NO. Prescribed by State Hoard of Accounts City Form No.201(Rev.1995) Vendor# 178002 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER KROGER CO IN SUM OF$ CITY OF CARMEL CENTRAL CUSTOMER CHARGES An invoice or bill to be properly itemized must show:kind ofservice,where performed,dates service rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. PITTSBURG, PA 15264-4467 Payee $134.09 ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police 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 134.09 43-430.03 $134.09 1 hereby certify that the attached invoice(s),or 1/28/17 134.09 refreshments-Klein retirement $134.09 1110 101 1110 101 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 Friday, February 10,2017 Green,Tim Chief of Police 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer P.O.Box 1648 Customer No: A03849 Hutchinson,KS 67504-1648 RETURN SERVICE REQUESTED Statement Date: 1/28/2017 Due-Date: DUE UPON RECEIPT Amount Due: $134.09 ACCOUNTS PAYABLE CARMEL POLICE DEPT 3 CIVIC SQUARE CARMEL,IN 46032 Current 29-56 Days 57-84 Days 85-112 Days 113+Days $134.09 $0.00 $0.00 $0:00 $0.00 ACCOUNT BILLING TICKET P.OJREF# CARD# STORE DATE TICKET . AMOUNT PROCESSED 1216455894 006851 000 959 01/03/2017 $15.97 1216455895 006516 000 959 01/03/2017 $102.94 1216456265 164293 010 959 ' 01/05/2017 .$15.18 For questions or copies,please contact Kroger Accounts Receivable toll free at 888-327-4911(Hyla ext.65563 or Sarah ext.61825)or by email(ayla.george@kroger.com or sarah:mueller@kroger.com).Please review your account promptly and advise if payments have been made.There will be a$5.00 fee for each ticket copy requested. Please retain the top portion for your records Page 1 of 1 Tan-atnnn Pprf—tion and Rphim Rnttnm Portion Page 1 of 1