185277 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC
CARMEL, INDIANA 46032 PO BOX 1106 CHECK AMOUNT: $1,282.55
NOBLESVILLE IN 46061
CHECK NUMBER: 185277
CHECK DATE: 5/11/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231400 GTO16869 1,282.55 GASOLINE
SALE 1255 DATE 04/29/16 16:53:13
COUNT: START 0.0 END 182.1
GROSS DELIVERY 182.1 GALLONS
4817 UNLEADED GAS GOVGASOLINE 1
MULTIPLE DELIVERIES AT SITE+
SALE 2441 DATE 04/3/10 16:51:57
COUNT; START 0.0 END 300.3
GROSS DELIVERY 300.3 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
Customer: 04OWS761 Invoice D: GT 016869
BROOKSHIRE GOLF CLUB Date: 4/2912010
CITY OF CARMEL Tiae: 17:01
12120 BROOK6W RE PKWY
CARMEL, IN 46033
Tros Terms Description Item Description Legend Quantity Unit Price Iteo Total
01 NORMAL 104817 UNLEADED GAS GOV'T E 182.10!@0 2.49M 453.43
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REITUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
(I.V.D.) ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P.S.I h'IAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST
THROUGH SEPTEMBER 15TH.
Federal' Road Tax me 0.00
State Road Tax 0.1BM 32.78
01 NORMAL 154040 DIESELEX ULS E 309.3006 2.70000 810.81
01 NORMAL 194070 PETRO VOLUME DISCOUN 482.4000 0.03000 -14.47
Legend: Invoice Subtotal: 1,282.55
E= Metered, T= Taxahle, =Entered by Hand Indiana Sales Tax On: 0.00 0.00
Invoice Total: 1,282.55
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1- 800 424 -9300 WE
APPRECIATE YOUR BUSINESS!!!
VOUCHER NO. WARRANT NO.
Hamilton County CO -OP ALLOWED 20
IN SUM OF
P.O. Box 1106
Noblesville, IN 46061
$1,282.55
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 GT 016869 42- 314.00 $1,282.55 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, May 06, 2010
1" l�
Director, Brook ire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 199:
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))
04/29/10 GT 016869 Fuel $1,2825
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
Clerk- Treasurer