180778 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 00352071 Page 1 of 1
ONE CIVIC SQUARE CLARK APPLIANCE SALES SERVICE CHECK AMOUNT: $519.00
ts 4� 1 CARMEL, INDIANA 46032 8801 BOEHNING LANE
4 `o INDIANAPOLIS IN 46219 CHECK NUMBER: 180778
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 21394 1000260005 519.00 SUB —ZERO FRIDGE REPAI
rlaf *ICE
Delivery Date 12/16/2009
Invoice 0005
1 8767 Boehning Lane Delivery (317) 898 -0135 Sales Order 2130064
j p P L 0. N C Indianapolis, IN 46219 Service (317) 890 -9202
Fax (317) 895 31 b l Customer CARMELSTRE
Customer PO
Salesperson
Coryell, Shawn
BILL TO: ustomer (317) 733 -2001 SOLD TO:
3400 West 131st St
Carmel Street Department Carmel Street Department
reef i 1 3400 West 131st Street
Westfield, IN 46074 4 Westfield. IN 46074
3 c Customer (317) 733 -2001
Model ti
Descri on Serial Brand Qty R Qt Unit Price Ext Price Tax
Service for SUB ZERO 1 $519.00 $519.00 $0.00
Motel 690S Serial 2099220
Remit To: SubTotal $519.00
Clark's Sales Service, Inc. Sales Tax $0.00
P.O. Box 44719 Total $519.00
Payer is —_$0.00
Madison, WI 53744 -4719
`Inyoiee'Due $5.19 =00
Terms NET 30
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
Clark Appliances ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
IN SUM OF CITY OF CARMEL
8801 Boehning Lane An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
h.idianapolis, IN 46219 whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
$519.00 Payee
Purchase Order No.
ON ACCOUNT OF APPROPRIATION FOR
Terms
Carmel Street Department
Date Due
Invoice Invoice Description Amount
PO Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members Date Number (or note attached invoice(s) or bill(s))
21394 1000260005 42- 370.00 $519.00 I hereby certify that the attached invoice(s), or 12/16/09 1000260005 $519.00
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
D Tuesda y December 22, 2009
OLOT:d/ J
Street Commission
Street (t itrmissioner
Cost distribution ledger classification if I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
claim paid motor vehicle highway fund with IC 5- 11- 10 -1.6
20
Clerk- Treasurer