188434 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 201250 Page 1 of 1
ONE CIVIC SQUARE MID STATE TRUCK EQUIP CORP
i CHECK AMOUNT: $19.00
CARMEL, INDIANA 46032 11020 ALLISONVILLE RD
FISHERS IN 46038 CHECK NUMBER: 188434
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 58619 19.00 REPAIR PARTS
MID -STATE TRUCK EQUIPMENT y Invoice
11020 Allisonville Road g pF Invoice Number:
Reta i I 001104675 -001 -0 e IRFi 58619
Fishers, IN 46038
Mid 5c:ECca`rruCk Eq� ppe� K
1 #1 Invoice Date:
Phone: 317.849.4903
Fax 31.849.6441.
www.miti-statetruck.com 7/21/2010
.7
Bill TO Ship To
CARMEL STREET DEPARTMENT
3400 West 131 Street
CARMEL, IN 46074
Handling charge added to Credit Customer P. O. N o. Terms
Card-orders over-$500.00: Visa
M/C 2 AMEX Discover- 3% SHOP NET 25 Days
Sales Rep ID Shipping Method Ship Date Due Date
DM UPS DROP SHIP 7/21/2010 8/15/2010
Qty Item Code Description Price Ea. Extension
2 PARTS 1 50983 DECAL 1.50 3.00
2 PARTS 52374 DECAL 1.00 2.00
2 PARTS] 74476 DECAL 2.00 4.00
1 FREIGHT TRANSPORTATION EXPENSES AND CRATING 10.00 10.00
EXPENSES
r
Serial
Serial Subtotal $19.00
Sales Tax (7.0 $0.00
Total Invoice Amount $19.00
Received by
Payment Received $0.00
1(k I Check# Authorization Code: Balance Due $1.9-00
Thank you for your business!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Mid -State Truck Equipment
IN SUM OF
11020 Allisonville Road
Fishers, IN 46038
$19.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 58619 42- 370.00 $19.00 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
Street Commissioner
#rat?# �f5m't1iC�it -rimer
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))
07/21/10 58619 $19.00
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