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187399 07/07/2010 a CITY OF CARMEL, INDIANA VENDOR: 357683 Page 1 of 1 I ONE CIVIC SQUARE ON SITE SUPPLY CARMEL, INDIANA 46032 5546 SHOREWOOD DRIVE SUITE 101 CHECK AMOUNT: $178.96 INDIANAPOLIS IN 46220 CHECK NUMBER: 187399 CHECK DATE: 7/7/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 26638 178.96 MATERIALS SUPPLIES t P In f Vice 5546 Shorewood Drive, Suite 101 Date Invoice Indianapolis, IN 46220 6/1512010 26638 Bill To Ship To City of Carmel Water Utilities City of Cannel Wastewater Utilities A/P Dept. Attn: Jerry 3450 West 131 St. 5484 East 126th St. Westfield, IN 46074 Carmel, IN 46033 P.O. Number Terms Rep Ship Via F.O.B. Net 30 MCC 6/15/2010 QTY Item Code Description U/M Price Each B/O Prev. Invd Amount 4 WIN 1420 Center -Flow band Towels, 660 Sheets/RL, 6RL /CS CS 44.74 0 0 178.96 Subtotal $178.96 On -Site Supply is a certified Small Disadvantaged Business (SDB) Phone Fax E -mail Sales Tax (7.0 $0.00 317- 259 -7788 or 888 -259- 7788 317- 259 -7700 orders @OnSiteontime.coin I 1 ota 1 $178.96 VOUCHER 102019 WARRANT ALLOWED 357683 IN SUM OF 6N SITE SUPPLY �QA d) 5546 SHOREWOOD DRIVE z SUITE 101 INDIANAPO IN 462 mss. Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 26638 01- 6200 -03 $178.96 Voucher Total $178.96 Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts City Form No. 241 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 1. An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 357683 ON SITE SUPPLY Purchase Order No. 5546 SHOREWOOD DRIVE Terms SUITE 101 Due Date 6/28/2010 INDIANAPOLIS, IN 46220 Invoice Invoice Description Date dumber (or note attached invoice(s) or bill(s)) Amount 6/28/2010 26638 $178.96 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 Date Officer