186929 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 361119 Page 1 of 1
ONE CIVIC SQUARE LUBRICATION SPECIALISTS OF NE FL
/a CARMEL, INDIANA 46032 4941 MARINERS POINT DR CHECK AMOUNT: $133.80
JACKSONVILLE FL 32225
o CHECK NUMBER: 186929
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 061005 133.80 GARAGE MOTOR SUPPIE
www.prolong- usa.com Lubrication Specialists of NE Florida, LLC
N V O I C E
INVOICE 061005 DATE: 06/07/10
PO VERBAL TERMS: NET 30
SHIP VIA: PALMER SALESPERSON: PALMER 317 -402 -0093
SOLD TO: DELIVER TO:
CITY OF CARM.EL SAME
CARMEL STREET DEPT.
3400 W. 131 ST.
WESTFIELD, IN 46074
ATTN: JEFF STEWART
ITEM QTY DESCRIPTION LIST PRICE: TOTAL
40020 12 PROLONG SPL 100- 12 oz. $9.90 $118.80
SUB TOTAL $118.80
TAX
INV. PROCESSED g V 7 DELIVERY $15.00
TOTAL $133.$0
PLEASE REMIT TO:
LUBRICATION SPECIALISTS OF NE FL
4941 MARINERS POINT DR.
JACKSONVILLE, FL 32225
317 -402 -0093
VOUCHER NO. WARRANT NO
ALLOWED 20
Lubrications Specialists of NE FL
IN SUM OF
4941 Mariners Point Dr.
Jacksonville, FL 32225
$133.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT
Board Member
2201 061005 42- 321.00 $133.80 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
r�! Thursday, June 17, 2010
l f/ e e o
i C g
Street Com sinner
Street -or ssioe
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))
06/07/10 061005 $133.80
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