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188331 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1 ONE CIVIC SQUARE GENERAL SHALE BRICK Jo CARMEL, INDIANA 46032 PO sox 71917 CHECK AMOUNT: $14.76 CHICAGO IL 60694 -1917 CHECK NUMBER: 188331 CHECK DATE: 8/3/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4236200 181277225 14.76 CEMENT n 'r General Shale Brick MMMMME Building The American Dream lnv©ice Invoice: 181277225 Invoice Date: 07/21/2010 Bill To: 279670 Customer P0: inlets CITY OF CARMEL 3400 W 131ST STREET Bill of Lading: 171432882 WESTFIELD IN 46074 -8267 Goods Issue Date: 07/21/2010 Order: 312322442 Sales Rep: 399 Ship -To: CITY OF CARMEL Order Loc.: Carmel 3400 W 131ST STREET CARMEL IN WESTFIELD IN 46074 -8267 Phone: 317 846 -2566 Mode-of Shipment: Customer Pickup 057 Material Material Description Quantity Price Value USD Batch Number and Description 6099001046 ESSROC BRIXMENT GRAY N 2 BAG 7.38 14.76 Subtotal 14.76 TAX TOTAL 14.76 LATE. PAYMEDIT_ CHARGE of 1.5'< PER _MONTH PLEASE RETURN THIS PORTION WITH YOUR PAYMENT Accnt Customer Name Invoice -Date Invoice Amount Due 279670 CITY OF CARMEL 07/21/2010 181277225 14.76 Remit To: GENERAL SHALE BRICK, INC. PO Box 71917 CHICAGO IL 60694 -1917 Terms: Take discount of $0.30 If paid on or before 08/20/2010 NET 45 DAYS. VOUCHER NO. WARkANT NO. ALLOWED 20 General Shale and Brick IN SUM OF P. O. Box 71917 Chicago, IL 60694 -1917 $14.76 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members 2201 181277225 42- 362.00 $14.76 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 Tuesday July 27 2010 ii AsAl S,re@C�ommissio�e Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts I 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)) 07/21/10 181277225 $14.76 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