187383 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 201250 Page 1 of 1
ONE CIVIC SQUARE MID STATE TRUCK EQUIP CORP CHECK AMOUNT: $103.30
CARMEL, INDIANA 46032 11020ALLISONVILLE RD
FISHERS IN 46038
CHECK NUMBER: 187383
CHECK DATE: 717/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 58488 103.30 REPAIR PARTS
MID -STATE TRUCK EQUIPMENT Invoice
1'1020 Allisonville Road f l l
v Invoice Number:
Retail 001104675-001-0
58488
Fishers, IN 46038 t�� Itric
r- s =�a•�c.2��e�e�'o� ��r��p�,y��< Invoice Date:
Phone: 317.849.4903'
www.mrd statetruck.com 6/24/201.0
Fax 317.849.6441
Bill To Ship To
CARMEL STREET DEPARTMENT
3400 West 131 Street
Westfield, IN 46074
Handling charge added to Credit Customer P.O. No. Terms
Card orders over $500.00: Visa
MIC 2 AMEX Discover 3% shop NET 25 Days
Sales Rep ID Shipping Method Ship Date Due Date
TMB P 6/24/2010 7/19/2010
Qty. Item Code Description Price Ea. Extension
DIXIE CHOPPER N -199
4 NUT 0.15 0.60 PARTS 1
4 PARTS I DIXIE CHOPPER B -328 BOLT 0.60 2.40
4 PARTS DIXIE CHOPPER W -108 LOCK WASHER 0.20 0.80
2 PARTS DIXIE CHOPPER 900220.A. SEAT BELTS 49.75 99.50
Serial
Serial Subtotal $1.03.30
Sales Tax (7 -0 $0.00
Total Invoice Amount $103.30
Received by
Payment Received $0.00
Check# Authorization Code: D Due $1.03.30
t
Thank you for-your business!
VOUCHE NO_ WARR NO.
ALLOWED 20
Mid -State Truck Equipment
IN SUM OF
11020 Allisonville Road
Fsshers, IN 46038
$103.3
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITt_E AMOUNT Board Members
2201 58488 42- 370.00 $103.30 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
Thufsday,, July 01, 2010
V
'v
Street Commissioner
Street
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts t 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))
06/24/10 58488 $103.30
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