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HomeMy WebLinkAbout186866 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER CHECK AMOUNT: $150.23 CARMEL, INDIANA 46032 PROCESSING CENTER PO BOX 656680 CHECK NUMBER: 186866 LOUISVILLE KY 40265-6680 CHECK DATE: 612312010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4238900 OOE011782108 /29.20 OTHER MAINT SUPPLIES 2200 4239099 DOE012004852 /3.99 OTHER MISCELLANOUS 1125 4350900 OOE012009535 151.19 OTHER CONT SERVICES 1091 4350900 OOE012120276 -37.90 OTHER CONT SERVICES 920 4239099 OOE012220610 .15.70 OTHER MISCELLANOUS 1701 4239099 OOE722032704 /12.25 OTHER MISCELLANOUS s• 0 service.icemountainwater.com B 215 6661 DIXIE HWY, SUITE 4 05/01110 05/31!10 00E0120095351 p LOUISVILLE KY 40258 rB ADDRESS SERVICE REQUESTED H 9 N H I0I 1 1 H I I ON II UI0I U IM ON WED JUN 21 0120095351 I WED- JUL 21 THU- AUG 19 MON- SEP 20 f 1Q asp CARMEL CLAY PARKS AND REC DEPT. Customer Service: 1- 800 472 -9888 AUDREY KOSTRZEWA 1411E 116TH ST Did you forget about us? Kindly pay upon receipt. Remember, past due accounts are subject to a late fee. CARMEL IN 46032 -3455 Your prompt payment is appreciated. For your convenience, pay online: icemountainwater.com /service. If payment has been made, we thank you. A, Get Arizona 13 veretl and SAVO*[ Add gcea4 tastin g ArlZonaalced Tea to your nextforclerP nose from- Lemon Tea, Green Tea; Dtet=Green Tea,Arnoldalmer'and Svueet Tea available` "iri 19;5 oz cans and alp gallon jugs Call or go onhnetoadd "to yo o rder% o-= t a x a. ACCOUNT ACTIVITY Pay your bill online at: service. icemountainwater.com or by phone at:1- 800472 -9888. It's free! BRUHR M MONSHIN 8 Delivery address: P CARMEL CLAY PARKS AND REC DEPT., 1427 E 116TH ST, CARMEL IN 46032 PREVIOUS BALANCE 45.09 5119 0672728219 6 5 GAL ICE MOUNTAIN DRK W /HANDLE 23.94 1 9 OZ PLASTIC UP 50C /SLEEVE 2.99 BOTTLE DEPOSIT: 6 CHARGED, 4 CREDITED 12.00 5/31 0675962476 1 OIL/FUEL SURCHARGE Purchase bR I NKING 11J�T�R 2.28 E9201395 RENT Descdptlon C QQL Fes, M aI LI-t 9.98 TOTAL P.O. P eT F 96.28 Purchaser Dat Approval Date ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 45.09 0.00 51.19 96.28 BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR 1. Please remember payment is due by the "pay by" date noted to ensure the smoothest service. A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2. Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means CALL I -800- 472 9888 OR WRITE us AT: your first invoice will include a pro -rated fee for the current month, plus the next month's rental. ICE MOUNTAIN SPRING NVATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. 4216 If you prefer, you can pay your bill online at service.icemountain.com. 6661 DIXIE HWY., SUITE 4 LOUISVILLE, KY 40258 4. Never hesitate to call us with comments, questions, or concerns. If you think your bill is wrong, or if you need more information about a transaction on your bill, write us on a separate sheet or paper. We must hear from you in writing no later than thirty (30) days after we S I NVOI C E sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Your name, address, telephone and account numbers. Date range of this invoice The dollar amount of the suspected error. Describe the error and explain if you can, why you believe there is an error. You are obligated to pay the parts of your bill that are not in question, z34se7s9 Your Account Number You do not have to pay the disputed amount while it is being ➢orooroo.ROlooloo investigated. During the investigation, we cannot report your account r 123456789 as delinquent or take any action to collect the amount in question. .HRa' p r match here for a GENERAL INFORMATION WroNo r�E -�rr'R personalized account L Payments received after the billing (iNVOTCE) date will appear on Important 1L11��111on1aB114M ..1111 "I.Itlh „:Illtl.11 „liddln rnen "yc °'r °ui "g1[EMW °ap0e�n, message your next invoice. Past due invoices (not paid within 30 days of news and billing date) may be assessed a late fee as allowed by law not to offers '23M.oeE exceed $20 per month. Additionally, third party collectionlattomey °ty sw' WOW I aaa.,,t n1. n II "n „bn I Ibld,a;;n expenses may be assessed at a rate not to exceed 100% of the unpaid balance or the maximum allowed by law. Pay electronically 2. Each returned check is subject to a service charge subject to the maximum check return charge allowable in your State."`” Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity amount has been ACTIVITY. since y our ACCOUNT ACrIVIT r w acvs4e °w°a n.ns^k ce =7M 5 1,99 4. Equipment replacement costs will be charged for bottles lost, P aid in full to }Est invo ucr ,yAee,n stolen, damaged or not returned. p,eel4�sRa,a °4e °s avoid late fees 5. In accordance with NWNA's Terms and Conditions "T &C your °4171 cry, 994 5 scu° Raw sa "y s°m n, 31]6R5144M ice MOamaln50al Oepa Lease and/or Service Agreement account may be Monthly Oil Equipment g Y o n1 n 7aesua^ u,nsce r.; 7,]0851 subject to minimum monthly purchases and/or early cancellation p3" R. 1 Su rchar ge, Fuel wr= 3826388„ fees. (A complete version of the currentT &C may be viewed on the 597 1661449] Surcharge or Delivery website listed below) Upon service discontinuation, rent for the l AL Fee (see 46 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued i "si:o AN l ".aNEN Information 6. You will be charged a monthly Oil Surcharge, Fuel Surcharge „o, °,.a�..W p' a 4 pp ppp--- CUN ENC. Delivery Fee as described in your T &C. Only one of these lets es Payment stub ACCO UNT SUMMARY will apply to each account. The fee that applies to your account AccouNT NUMBER ro is stated on the front of the invoice. For further information please fp,,.r a �e rort R1u,NC DATE NUMaER oalaoloa visit the website listed below or contact our customer service ,NVOicE 1Z34s6]R9° 1r Ht center. a, w R R„ n,v..•.w- .r,.vueavrsxa.r�sns>P. t 94282712614 ➢0039104'1 209 L� 7. As a food product, bottled wat 092[1896307 r subject to the rules and e r Amount due regulations promulgated by th� erdl"`F�bd "and "Diirg" 1 —C- Administration(FDA). ICr MOUNTAIN WATER COM"ANV C7 -is e5toaoo° 8. Your first invoice indicates the• prodttLt 's"'deHvdttd "on "yoSr� "fir'st �.M Submit your 1`. FOR CI1910MER 9rMlCE GAIL IB°O<]29R 0 delivery, along with any applicable bottle and account deposits, pay b y this V„dn.l�.l,.nu II l:ll,.LaLkl.Ld.a e r. ^y..a,�x.+ "uswe. P redemption fees, and any dispt: Wr,.chaz$cs.,All,.future- mvoices- -y ^y °e °^��ed°^" "`s'°` 0 date will reflect charges for water delivered and dispenser rental, bottle 5jrv0PF a: deposits and credits plus charges, .fot,any�'a y_ dditional- products- ordered by you. Deliveries are made every three,os four weeks, for a total of 16 -17 deliveries per yef*Wi in o rdceNT'invoices 12 times per year, so approximately 5 of those invoices will reflect two deliveries. 2008 Ice Mountain Spring Water Company a Division of Nestle Waters North America Inc. Form No. NW 709 11108 service. icemountain.com sorvice. loom ountaInwater.ccm Tram A "m 215 6661 DIXIE HWY SUITE 4 05/01/10 05/31/10 OOE0121202766 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED F1 e MON- JUN 21 0121202766 WED- JUL 21 T il l H U- AUG 19 MON- SEP 20 CITY OF CARMEL PARKS DEPARTMENT a Customer Service: 1-800-472-9888 MANDY SPADY Did you forget about us? Kindly pay upon receipt. 1411 E 116TH ST `Remember, past due accounts are subject to a late fee. CARMEL IN 46032 -3455° Your prompt payment is appreciated. For your Il� III' Ill�ill' �I l I�' I'llll "IIIIII'lll "II'l'll'i�lll convenience, pay online: icemountainwater.com /service. If payment has been made, we thank you. Get ArlZana Delivered and SAy8rAdd great tasting AtiZonaeIced Tea to your'next order Choose from Lemon Tea, GreeniTea Didt°Green Tea',- Sweet Tea aV-ailabfie In 11:5 oz cans antl l gallon J w s "Call or go�online to add to your order *a. ACCOUNT ACTIVITY Pay your bill online at: service. icemountainwater.com or by phone at:1- 800 472 -9888. It's free! n. 1 2 r Mal Delivery address: PREVIOUS BALANCE 23.92 5119 0672728284 6 5 GAL ICE MOUNTAIN DIRK W /HANDLE 23.94 2 9 OZ PLASTIC UP 50C /SLEEVE 5.98 1 .5 L NATURAL SPRING WATER ICE MTN 5.99 BOTTLE DEPOSIT: 6 CHARGED, 7 CREDITED -6.00 5/31 0675891733 1 OIL /FUEL SURCHARGE Purchase DkIMKJNI(:� ln! T R 2.00 E9274021 RENT p99cNptlort R, 5.99 TOTAL P.O. p or F 61.82 a.L. a 1:09 5G Cho Budget Line oescr _Ql�iP r o-c 8VC-5 Purchaser Date-- Approv Date ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT'+ Q Subject to terms on reverse side. 23.92 0.00 37.90 61.82, ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 051125 Ice Mountain Terms P.O. Box 856680 Louisville, KY 40285 -6680 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 613!10 OOE0120095351 Water cooler lease 51.19 613110 OOE0121202766 Water cooler lease 37.90 Total $9.09 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 1 20 Clerk- Treasurer Voucher No. Warrant No. 051125 Ice Mountain Allowed 20 P.O. Box 856680 Louisville, KY 40285 -6680 In Sum of 89.09 ON ACCOUNT OF APPROPRIATION FOR 101 General 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 OOE0120095351 4350900 51.19 1 hereby certify that the attached invoice(s), or 1091 00ED121202766 4350900 37.90 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 17 -Jun 2010 Signature 89.09 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund service.icemountainwater.com 0 215 6661 DIXIE HWY, SUITE 4 05/01/10 05/31/10 OOE0117821082� 0 LOUISVILLE KY 40258 v ADDRESS SERVICE REQUESTED e H M 11101 ME II 010 �II0H M FRI JUN 18 0117821082 TUE- JUL 20 WED- AUG 18 FRI- SEP 17 Customer Service: 1 800 472 9888 CITY OF CARMEL STREET DEPATMENT Did you forget about us? Kindly pay upon receipt. 3400 W 131 ST ST Remember, past due accounts are subject to a late fee. WESTFIELD IN 46074 -8267 Your prompt payment is appreciated. For your 111' 1" 11"' 11' 111111111111 "'I' convenience, pay online: icemountainwater.com /service. If payment has been made, we thank you. etArlZona Delivered and'SAVEI Add gr,.eat tasting ArlZona {t;etlTea to your nett arrier Choose frornw demon Tea, Green Tea; DIet.Greeri "Tea, APnoid Palmer:and Sweet Tea available in 11:5 oz Cans antl 1 gallon lugs Call or go onilne =to add to dour orders T F T a' a n .,s, r_P- m. p ..,rte s.ea a.=...�.,,� a.:.a ze, E° a.. ACCOUNT ACTIVITY Pay your bill online at: service. icemountainwater.com or by phone at: 1 -800-472-9888. It's free! E� D elivery address: PREVIOUS BALANCE 26.13 5117 0672415023 3 9 OZ PLASTIC UP 50C /SLEEVE 8.97 4 5 GAL ICE MOUNTAIN DRK W /HANDLE 13.96 4 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 24.00 4 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -24.00 5131 0675874689 1 OIL /FUEL SURCHARGE 2.28 E9177509 RENT 3.99 TOTAL 55.33 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT 1 ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 26.13 0.00 29.20 55.33 VOUCHER NO. WARRA NO. ALLOWED 20 Ice Mountain IN SUM OF P. O. Box 856680 Louisville, KY 40285 -6680 $29.20 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member 2201 OOE0117821082 42- 389.00 $29.20 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 1 1 Thursday Milne 17, 2010 I/ Street Commissio Q lresci 2;�m Ijss t�! lt;i Title 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 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)) 06/03/10 OOE0117821082 $29.20 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 service.!cemountainwater.com I a a fl 215 6661 DIXIE HWY, SUITE 4 05/01/10 05/31/10 OOE0122206105 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED a THU- JUN 17 II I I II I I f �'�I1II II III I II II III 0122206105 MON- JUL 19 TUE- AUG 17 THU- SEP 16 CITY OF CARMEL ENGINEERING /1ST AVE Customer Service: 1- 800 -472 -9888 KAREN NOLAN Did you forget about us? Kindly pay upon receipt. 1 CIVIC SQUARE Remember, past due accounts are subject to a late fee. CARMEL IN 46032 -2584 Your prompt payment is appreciated. For your "'lllllll'I'I'll'�IIII�' 1111" IIeII�II�IIn11�1�1�1�111111���1I� convenience, pay online: icemountainwater.comiservice. If payment has been made, we thank you. Get A iZona ©eIN"t d and- SAVERAdd great= tasting Ai iZona -Iced Tea to�your next�oraler. Choose tenon Tea, GreenTea; Diet GreenTea, Arhnold Palmer and Sweet Tea available in 11.5oz cans and f gallon ;lugs. Callor�goagnllneto atld,atoioar,drder m ACCOUNT ACTIVITY Pay your bill online at: service.icemountainwater.com or by phone at:1- 800 -472 -9888. It's free! Delivery address: CITY OF CARMEL ENGINEERING, 130 1ST AVENUE SOUTHWEST, CARMEL IN 46032 PREVIOUS BALANCE 97.57 5109 925930 PAYMENT -THANK YOU -44.16 5114 0672011855 2 9 OZ PLASTIC UP 5OC1SLEEVE 5.98 1 .5 L NATURAL SPRING WATER ICE MTN 5.99 3 5 GAL ICE MOUNTAIN DRK WIHANDLE 10.47 1 BOTTLE ST E DEPOSIT: 3 CHARGED, 7 CREDITED ,;r 0 24.00 5131 0675789507 1 OILIFUEL SURCHARGE r• 2.28 E9179445 RENT 3.99 TOTAL 69.11 JUN i�� f :_5 dg 4 D ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ADJUSTMENT CURRENT ACTIVITY PAY THIS`A .7 UNT Subject to terms on reverse side. 97.57 44.16 15.70 69.11 our payment Prescribed by State Board of Accounts 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 Ice Mountain Dire Purchase Order No. NA P O Box 856 Terms Louisville, KY 402 -6680 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/ OOE0122 Keystone Re Project $1 5.70 Miscellaneous Project 07 -0 Total $15.70 .I hereby certify that the attached invoice(s), or bills(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer r VOUCHER N0, WARRANT NO. Ice Mountain Direct ALLOWED 20 PO Box 856680 IN THE SUM OF Louisville, KY 40258 -6680 15.70 ON ACCOUNT OF APPROPRIATION FOR Ice Mountain Direct PO# or INVOICE NO. ACCT /TITLE AMOUNT Board Members DEPT.# NA OOE0122206105 4239099 $15.70 NA I hereby certify that the attched 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 21 -Jun 20 10 Total $15.7 Signature Cost distribution ledger classification if City En claim paid motor vehicle highway fund Title V PIJ I "A� A service. icemountainwater.com p p e 215 6661 DIXIE HWY, SUITE 4 05/01/10 05/31/10 OOE0120048525 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED 9 e IIIIIIIIIIIIIIIIIII111IIII11111111 FRI- JUN 25 0120048525 TUE- JUL 27 WED- AUG 25 FRI- SEP 24 CITY OF CARMEL DEPT OF ENGINEERING Customer Service: 1- 800 472 -9888 LISA SCOTT OR JUDY STOHLER YOUR ACCOUNT IS SERIOUSLY DELINQUENT and is 1 CIVIC SQ subject to additional late fees. You must make immediate CARMEL IN 46032 -2584 payment to avoid collection action. For your II' III'' II�I�IIIII��III' �I�III "�'I� "�'llll' convenience, you can pay by phone. Please call today! s Get Arizona Det vere'tl and'SAVE= !.�Add ArtZona Iced T a to your next order Ghoose from a z Lemon Tea, Green Tea, Det�Green Tea; A Palmerrand,Sweet Tea�a�ailablein 11 5 0 cans a gallon to dugs Calf or go online a dyt" our ;orde ce x^ a s i �sa., ACCOUNT ACTIVITY Pay your bill online at: service.icemountainwater.com or by phone at: 1 -800-472-9888. It's free! Delivery address: CITY OF CARMEL TOWN HALL ENGINEERING, 1 CIVIC SO, CARMEL IN 46032 PREVIOUS BALANCE 68.39 5109 925929 PAYMENT -THANK YOU -17.45 5/31 E9188455 RENT 3.99 TOTAL 6 -y ro 54.93 P f U 1 kP 4°a F ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT /ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 68.39 17.45 3.99 54.93 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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. Ice Mountain Payee Purchase Order No. OX Terms Louisville, KY 40285 -6680 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06103/10 OOE Rent and Servie April $3.99 ccn Total 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 VOUCHER NO: WARRANT NO. ALLOWED 20 Ice Mountain IN SUM OF P.O. Box 856680 Louisville, KY 40285 -6680 ON ACCOUNT OF APPROPRIATION FOR Department of Engineering Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for Ac nt 0120048525 which charge is made were ordered and received except �n 21 20 Signature C'� �{r YtT T i Cost distribution ledger classification if T claim paid motor vehicle highway fund 41 1 T service.1cemountainwater.com 10 9 215 6661 DIXIE HWY, SUITE 4 05/01/10 05/31/10 OOE7220327048 LOUISVILLE KY 40258 B e ADDRESS SERVICE REQUESTED FRI JUN 25 7220327048 TUE- JUL 27 WED- AUG 25 FRI- SEP 24 CITY OF CARMEL OFFICE OF THE CLERK TREASURER Customer Service: 1- 800 472 -9888 ANN DAVIS Did you forget about us? Kindly pay upon receipt. 1 CIVIC SO Remember, past due accounts are subject to a late fee. CARMEL IN 46032 -2584 Your prompt payment is appreciated. For your I�I�l�lll�lll' �Illllllllllr�I�III `I��II�II�I�II "'ll'I'll�lll'I" convenience, pay online: icemountainwater.com /service. If payment has been made, we thank you. het ArIZoDelivered and SAVEIAdd, great tasting AIrlZona Iced7ea to your next order Choose from y Lepton Tea, Green Tea, Diet Greenarea,;Arnold Palmer antl�Sweet',4Tea available in 11. -S.oz cans and gallon 3 dugs Call ar go online to atltl' to your order v u s..- «w.tu.:.: `'"-L,° gi. .fi.,m., a;' r ACCOUNT ACTIVITY Pay your bill online at: service. icemounta inwater.com or by phone at:1- 800 -472 -9888. It's free! e Delivery address: -CITY OF CARMEL OFFICE OF CLERK TREASURER, 1 CIVIC SO, CARMEL IN 46032 PREVIOUS BALANCE 22.64 5125 0674844345 3 5 GAL ICE MOUNTAIN DRK W /HANDLE .00 3 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT .00 3 5 GALLON ICE MOUNTAIN DEPOSIT RETURN .00 2 9 OZ PLASTIC UP 50CISLEEVE 5.98 5131 0675762504 1 OIL /FUEL SURCHARGE 2.28 E9213248 RENT 3.99 TOTAL 34.89 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT I ADJUSTMENT CURRENT ACTIVITY PAY THIS -AMOUNT Subject to terms on reverse side. 22.64 0.00 �255--- 34.89 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER Ckty Form No. 201 (Rev. 1995) 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. r tl �Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 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 VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF f ON ACCOUNT OF APPROPRIATION FOR Board Members PO4 or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the `1 materials or services itemized thereon for which charge is made were ordered and received except r 'mo 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund