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186315 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1 e `'f ONE CIVIC SQUARE GENERAL SHALE BRICK CHECK AMOUNT: $1,051.20 CARMEL, INDIANA 46032 PO BOX 71917 CHICAGO IL 60694 -1917 CHECK NUMBER: 186315 CHECK DATE: 6/912010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 206 4237001 181243467 1,051.20 STORM SEWER MAINT SUP ,,General Shale Brick MWMWME Building The American Dream f n ©ice Invoice: 181243467 Invoice Date: 05/28/2010 Bill To: 279670 Customer P0: shop CITY OF CARMEL 3400 W 131ST STREET Bill of Lading: 171395436 WESTFIELD IN 46074 -8267 Goods Issue Date: 05/28/2010 Order: 312 080874. 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: Truck 057 Car or Truck -No: KIRK Material Material Description Quantity Price Value USD Batch Number and Description 6099001047 ESSROC BRIXMENT GRAY S 100 BAG 7.83 783.00 6099010275 4 X 8 X 16 SOLID BLOCK 120 EA 1.61 193.20 6000000000 Additional Freight 1.000 UOB 75 "00 75.00 Subtotal 1,051.20 TAX TOTAL 1,051.20 LATE PAYMENT CHARGE--of" PLEASE RETURN THfS PORTION WITH YOUR PAYMENT Accnt#: Customer Name Invoice -Date Invoice Amount Due 279670 CITY OF CARMEL 05/28/2010 181243167 1,051.20 Remit To: GENERAL SHALE BRICK, INC. PO Box 71917 CHICAGO IL 60694 -1917 Terms: Take discount of $19.52 If paid on or before 06/27/2010 NET 45 DAYS. VOUCHER NO. !,NARRANT NO. General Shale and Brick ALLOWED 20 IN SUM OF P. O. Box 71917 Chicago, IL 60694 -1917 $1,051.20 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE I AMOUNT Board Member; 206 181243467 42 370.01 $1,051.20 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 Thldaylffne 03, 2010 v Street Commissioner Yi Str<?cii C tiu�iti a9f Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be property 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)) 05/28/10 181243467 $1,051.20 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