183819 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
4 ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC CHECK AMOUNT: $532.62
CARMEL, INDIANA 46032 PO BOX 11106
NOBLESVILLEIN 46061 CHECK NUMBER: 183819
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231300 GTO16613 532.62 DIESEL FUEL
SALE 2217 DATE 03119110 140:19
COUNT: START 0.0 END 212.2
GROSS DELIVERY 212.2 GALLONS
4040 DIESELEX ULS DISTILLATI
MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO -OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: GT GARY TEETERS
Custouer: 0000031175 Invoice R: OT 016613
CARNEL STREET DEPT pate: 3/19/2010
3400 W 131ST STREET Tine: 1428
WESTFIELD, IN 46074 t
Tres Terns Description Item Description Legend 4uantity Unit Price Iteo Total
01 NORMAL 154040 DIESELEX ULS E 212.2000 2.54000 538.99
01 NORMAL 134070 PETRO VOLUME DISCOUN ff 212.2090 0.03000 -6.37
Legend: Invoice Subtotal: 532.62
E-Metered, T= Taxable, Entered by Hand Indiana Sales Tax On: 0.00 0.00
Invoice Total: 532.62
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES.; IN CASE OF EMERGENCY C'ONT'ACT CHEpTTREC AT 1- 800 -424 -9300 WE
APPRECIATE YOUR BUSINESS !11
i
VOUCHER NO. WARRA NO.
ALLOWED 20
Hamilton Co. Co -op
IN SUM OF
P. O. Box 1106
Noblesville, IN 46061
$532.62
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Member:
2201 GT 016613 42- 313.00 $532.62 1 hereby certify that the attached invoice(s), or
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
Thursday, March 25, 2010
U /1� r�Street Corq'Wd�jo r���
L b
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts I 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
03/19/10 GT 016613 $532.62
1 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
Clerk- Treasurer