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a! 4� CITY OF CARMEL, INDIANA VENDOR: 372296
® �• ONE CIVIC SQUARE JACKSON OIL&SOLVENTS, INC. CHECK AMOUNT: $*****1,200.00*
s ;a CARMEL, INDIANA 46032 75 REMITTANCE DRIVE,DEPT 6988 CHECK NUMBER: 326784
9%ir`ori"�°`. CHICAGO IL 60675-6988 CHECK DATE: 06/29/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 001104034 1,200.00 OTHER EXPENSES
VOUCHER NO. 185838 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
Vendor # 372296 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
JACKSON OIL&SOLVENTS INC CITY OF CARMEL
75 REMITTANCE DRIVE An invoice or bill to be properly itemized must show: kind of service,where performed,
DEPT 6988 dates service rendered, by whom, rates per day, number of hours, rate per hour,
CHICAGO, IL 60675-6988 numbers of units, price per unit, etc.
Payee
$1,200.00 372296 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR JACKSON OIL&SOLVENTS INC Terms
Carmel Wasterwater Utility 75 REMITTANCE DRIVE Due Date
BOARD MEMBERS DEPT 6988
I hereby certify that that attached invoice CHICAGO, IL 60675-6988
(s),
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT for which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
001104034 01-7363-06 $1,200.00 and received except 6/21/2018 001104034 $1,200.00
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_
Clerk-Treasurer
JACKSON OIL & SOLVENTS, INC. Original Invoice
75 REMITTANCE DRIVE DEPT 6988 Page 1
CHICAGO,IL 60675-6988
(317)636-4421 * (800)221-4603
Invoice No: 001104034 1 Invoice Date: 06/15/2018
Order No: 128582800 Load Date: 06/11/2018
Purchase Order No: 0 Reference No: 0
Bill of Lading No: 0 Shipped Via: JACKSON OIL GEN DEL.
1
Bill To: 742600 Ship To: 742600
CARMEL WASTEWATER-SEWER CARMEL WWTP
9609 HAZEL DELL PARKWAY 10601 HAZEL DELL PKWY
INDIANAPOLIS,IN 46280 INDIANAPOLIS,IN 462800000
Product Description Price Order Qty Ship Qty Extended Price
98FFS EA FUEL FILTER&TRANSFER 1,200.000 1.00 1.00 $1,200.00
INSX IN SALES TAX EXEMPT 0.000% 1,200.00 $0.00
Date Due: 07/15/2018 Invoice Total: $1,200.00
Please pay from invoice and remit to address above.