185744 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
ONE CIVIC SQUARE GENERAL SHALE BRICK
CHECK AMOUNT: $9.99
CARMEL, INDIANA 46032 PO BOX 71917
•c, o CHICAGO IL 60694 -1917 CHECK NUMBER: 185744
CHECK DATE: 5/2612010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236100 181227566 9.99 SAND
-1
General Shale
Brick
Building The American Dream
Invoice: 181227566 Invoice Date: 05/05/2010
Bill To: 279670 Customer P0: SHOP
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 171378494
WESTFIELD IN 46074 -8267 Goods Issue Date: 05/05/2010
Order: 311986515
Sales Rep: 399
Ship -To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074 -8267 Phone: 317 846 -2566
Mode of Shipment: Customer Pickup 057
Material Material Description Quantity Price Value USD
Batch Number and Description
6099008469 50 LB. OF SAND 3 BAG 3.33 9.99
Subtotal 9.99
TAX
TOTAL 9.99
LATE PAYMENT CHARGE— of- 1-.-5s -PER MONTH.
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT
Accnt4: Customer Name Invoice -Date Invoice Amount Due
279670 CITY OF CARMEL 05/05/2010 181227566 9.99
Remit To: GENERAL SHALE BRICK, INC.
PO Box 71917
CHICAGO IL 60694 -1917
Terms: Take discount of $0.20 If paid on or before 06/04/2010 NET 45 DAYS.
VOUCHER NO. WARRANT NO.
ALLOWED 20
General Shale and Brick
IN SUM OF
P. O. Box 71917
Chicago, IL 60694 -1917
$9.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 181227566 42- 361.00 $9.99 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
/h,(rsda Pay ay 20, 2010
I v'
ti I
Street Commiss�ioher
1`itle
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 261 (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))
05/05110 181227566 $9.99
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