186347 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 359475 Page 1 of 1
0 z, ONE CIVIC SQUARE HELENA CHEMICAL CO
CARMEL, INDIANA 46032 98324 COLLECTION CENTER DR CHECK AMOUNT: $3,755.20
CHICAGO IL 60693 -0963 CHECK NUMBER: 186347
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4238900 73654795 640.00 OTHER MAINT SUPPLIES
1207 4238900 73654796 3,115.20 OTHER MAINT SUPPLIES
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(Liberty Center (IN)) Helena Chemical C o]7��
3073 S Main St Invoice 73654796
Liberty Center IN 46766
260_694 -6926
Invoice bate 0511912010
Bill To CITY OF CARMEL BROOKSHIPE GOLF COURSE Due Date 06/15i2010
12120 BROOKSHIRE PWY Customer ID 3576723
CARMEL IN 46033
Satesperson 17090
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Shipping Loc. 1
Ship To: 12120 BROOKSHIRE PWY
CARMEL, IN 46033
Ticket(6) 73643826
Quantity Description Unit Price Total
132.000 LBS Chipco Signature (4x5.5 Lb)(Lbs) 23.60 /LBS 3,115.20
Sub' Total 3,11520
NOTE: By acceptance of the products or services reflected on this invoice, the purchaser agrees to be bound by Amount: Due 3,,115.20
all the terms and conditions of sale set forth in this invoice, including those on the reverse side of this invoice.
Remit To: Helena Chemical Company
98324 Collection Center Drive
Chicago IL 60693 -0983
Recommendation Was Made By or Provided to the Seller. Yes No Invoice 73654796
CITY OF CARMEL BROOKSHIPE GOLF COURSE
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(Liberty Center (IN)) Helena Chemical Co
3073 S Main St invoice 73654795
Liberty Center IN 46766
2.60_694 -6926
Invoice Date 05/19/2010
Bill To i:CITY OF CARMEL BROOKSHIPE GOLF COURSE Due Date 06/15/2010
12120 BROOKSHIRE PWY
Customer ID 3576723
CARMEL, iN 46033
Salesperson 17090
l
Shipping
Ship To: 12120 BROOKSHIRE PWY
CARMEL, IN 46033
Ticket(s)'''
ickets) 73643832
1
Comments: UPSed from Watervliet
Quantity Qes criptton Unit Price Total
5.000 GAL Goemar MZ'O' (2x2.5 Gal)(Gal) 128.00 /GAL 640.00
NOTE: By acceptance of the products or services reflected on this invoice, the purchaser agrees to be bound by Amount Due 640.00
all the terms and conditions of sale set forth in this invoice, including those on the reverse side of this invoice.
Remit To: Helena Chemical Company
98324 Collection Center Drive
Chicago IL 60693 -0983
Recommendation Was Made By or Provided to the Seller. Yes No Invoice 73654795
CITY OF CARMEL BROOKSHIPE GOLF COURSE
u 4 INDIANA RETAIL TAX EXEMPT PAGE
i Carmel CERTIFICATE NO. 003120155 002 0 �Y o A PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
HL
VENDOR E 4 n+. �?k:1--/ ��3
To
1 4 t L.j jI _9
CONFIR.110N BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION 1 UNIT PRICE EXTENSION
/4 Zf n -1 t x'15 —r t�
P
1A A
1 4 a
Send Invoice To:
1za /C,/ &tub
ep -r_y y� 6 3
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Q j/ cS g PAYMENT y�
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY, THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ff
SHIPPING LABELS. S�f
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 5545 TITLE �9
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 CLERK- TREASURER
DOCUMENT CONTROL NO A.P.V, COPY SIGN AND RETURN TO CLERK OFFICE
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF PROPRIATION FOR
Board Members
PO# or INVOICE N0. ACCT /TITLE AMOUNT
DEPT, I hereby certify that the attached invoice(s), or
Q�{j�rP 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_
1
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
r
VOUCHER NO. WARRANT NO.
ALLOWED 20
Helena Chemical Company
IN SUM OF
98324 Collection Center Drive
Chicago, IL 60693 -0983
$3,755.20
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT
Board Members
1207 73654796 42 389.00 $3,115.20 1 hereby certify that the attached invoice(s) or
1207 73654795 42 389.00 $640.00
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
Monday, May 24, 2010
Director, Brooksh Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Stale Board of Accounts City Form No. 201 (Rev 1W
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))
05/19/10 73654796 Fertilizer $3,115.2
05/19/10 73654795 Fertilizer $640.0
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