329347 08/27/18 a`%��,q,,f. CITY OF CARMEL, INDIANA VENDOR: 356009
ONE CIVIC SQUARE R G A/HOOSIER RUBBER &TRANSMISS�CK AMOUNT: $......*797.30*
:� a° CARMEL, INDIANA 46032 3905 EAST PROGRESS STREET - CHECK NUMBER: 329347
9M,�TON�°` NORTH LITTLE ROCK AR 72114 CHECK DATE: 08/27/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 226953001 797.30 OTHER EXPENSES
VOUCHER NO. 186248 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995)
Vendor# 33$590- 35l(,volIN SUM OF$ ACCOUNTS PAYABLE VOUCHER
RGA/HOOSIER RUBBER&TRANSMISSON CITY OF CARMEL
3905 E. Progress Street An invoice or bill to be properly itemized must show: kind of service,where performed,
North Little Rock, AR 72114 dates service rendered, by whom, rates per day,number of hours, rate per hour,
numbers of units, price per unit,etc.
Payee
797.30 350590 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR RGA/HOOSIER RUBBER&TRANSMISSON Terms
Carmel Wasterwater Utility 3905 E. Progress Street Due Date
BOARD MEMBERS
I hereby certify that that attached invoice North Little Rock,AR 72114
(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
I26953-001 01-7202-06 $797,30 and received except 8/15/2018 I26953-001 $797.30
l
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
INVOICE
MAIL REMITTANCE TO: ENTERING OFFICE INVOICE NUMBER TRAN
CODE
126953-001 DI
RGA RGA 2002 LAFAYETTE RD. INVOICE DATE PAGE
AN EMPLOYEE OWNED COMPANY '
INDIANAPOLIS IN 46222 08/08/18 1
3905 East Progress Street
Any different or additional terms that may be embodied in your purchase order are hereby objected to. If your order is not an
North Little Rock, AR 721 14 acceptance of our proposal,this will operate as an acceptance of your order only in the event you agree to the terms hereof.
The terms and conditions contained above and attached shall apply.
T.
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::;.;:.:.:<.;:;:...Q 1 Sf�1P.•: IOC+I.......................................PAL1f..... ..............................1 SG UN....�a........................AMOUAIf.....
10 40 40 BLTR-HD-RUBBER-BELT-FT 18.6000 744.00
39"WIDE 3PLY BLTR FT
APPROX. 3/8"THICK
50 2 2 PLAU-UHMW-EA 26.6500 53.30
1/2"X6"X13-1/2" PLAU EA
FOLD
COST. NO. ORDER DATE TERR PCORD Written By DATE SHIPPED WHSE AMOUNT 797.30
TC125 07/30/18 TC 70 S TJS 08/08/18 70
FRGHT/INS/HNDL .00
Carrier: CALL CUST FOB: SP,FNA,PREPAID ORIGINAL INVOICE SALES TAX .00
__Tracking:- __ — _ __
Terms of Payment: NET 30 DAYS INVOICE TOTAL 797.30
Please Pay This Amount
ORDER ISSUED IN: INDIANAPOLIS
Note New Remit To Address: PHONE: 317/634-3976
3905 East Progress Street
North Little Rock, AR 72114
Customer PO No. S18728 Mark No. DUANE 317-571-2634 X1640
s CARMEL UTILITIES s CARMEL WASTE WATER
0 9609 HAZELDELL PKWY H 9609 HAZEL DELL PARKWAY
D P
T INDIANAPOLIS IN 46280 T INDIANAPOLIS IN 46280
0 0
F From: RGA
RGA 2002 LAFAYETTE RD.
AN EMPLOYEE OWNED COMPANY INDIANAPOLIS IN 46222
CUST
?': MARK
nMioRIiAN .E. �7T... . >:»»:::> :::::::>::::>::::»::>::>::.:::>::<>:::<:: No. DUANE 317-571-2634 X1640
S S
O CARMEL UTILITIES H CARMEL WASTE WATER
L 9609 HAZELDELL PKWY 1 9609 HAZEL DELL PARKWAY
D P
T INDIANAPOLIS IN 46280 T INDIANAPOLIS IN 46280
O O
ORDER DATE SALES ORDER NO. PAGE WRITTEN ORIGIN
07/30/18 126953-001 1 TJS 70
IPNI NT>FR IW 'A ND1ANAPOLIS '1NAREHOUSE.'�
SH E 0 .OU I.
.. ..
LINE CURRENT PART NUMBER UNIT QUANTITY
OPEN OF
NO. QUANTITY DESCRIPTION PRODUCT WEIGHT MEAS RELEASED SHIPPED
10 40 BLTR-HD-RUBBER-BELT-FT FT 40 [ l
39"WIDE 3PLY BLTR
APPROX. 3/8"THICK
50 2 PLAU-UHMW-EA EA 2
1/2"X6"X13-1/2" PLAU
QUESTIONS ABOUT YOUR ORDER? CALL 317-634-3976
We hereby certify that these goods were produced in compliance with THE PRODUCTS LISTED ABOVE MEET THE
all applicable requirements of Section 6,7,and 12 of the Fair Labor REQUIREMENTS AND SPECIFICATIONS OF THE
Standards Act,as amended,and of regulations and orders of the STANDARDS UNDER THE OCCUPATIONAL
United States Department of Labor issued under Section 14 thereof. SAFETY AND HEALTH ACT OF 1970. PACKING LIS 1T