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190953 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 359498 Page 1 of 1 0 ONE CIVIC SQUARE SHELBY MATERIALS CHECK AMOUNT: $696.9fi CARMEL, INDIANA 46032 P o BOX 242 SHELBYVILLE IN 46176 CHECK NUMBER: 190953 CHECK DATE: 1011312010 DEPART A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4238900 378462 696.96 OTHER MAINT SUPPLIES INVOICE .CUSTOMER °NQ. DATE INVUCE NO. PAGE TM M A T E R I A L_ S BR001 09/30/2010 378462 1 The Concrete and Aggregate Experts 0 317 -398 -4485 FAX 317 -398 -2727 13ROOKSHIRE GOLF CLUB CITY OF CARMEL Send remittance to: 12120 BROOKSHIRE PKWY Shelby Materials P.O. Box 242 CARMEL, IN 46033 Please attach top part Shelbyville, Indiana 46176 with your remittance. Detach Here JOB NUMBER LOCATION ADDRESS pt DATE' PRICE TAX' TOTAL I QUANTITY UNIT DESCRIPTION UN1T r 000201 GOLF COURSE PO NUMBER: G -98 09/27 032 452215 23.57 TN TOP DRESSING SAND 21.250 500.86 09/27 032 452215 23.57 TN DELIVERY CHARGE 8.000 188.56 09/27 032 452215 0.94 TN FUEL SURCHARGE 8.000 7.54 JOB TOTAL LINE 696.96 O t r t J J+ i; f INVOICE 696.96 i4MOUNT DUE TERMS: NET 30 DAYS -THERE WILL BE A FINANCE CHARGE OF 2.00% PER MONTH (24 o PER ANNUM) ON ALL ACCOUNTS PAST 30 DAYS. ALL ACCOUNTS, WITHOUT PRIOR APPROVAL, WHICH HAVE OUTSTANDING BALANCES OVER 90 DAYS, WILL BE TEMPORARILY PLACED ON C.O.D.THE ACCOUNT WILL REMAIN ON A C.O.D. BASIS UNTIL BALANCE IS PAID OR SUITABLE ARRANGEMENTS ARE MADE WITH THE CREDIT DEPARTMENT. ALL ACCOUNTS TURNED OVER FOR COLLECTION WILL INCUR REASONABLE ATTORNEY FEES AND COURT COSTS TO BE PAID BY THE PURCHASER WITH PROPER VENUE AS SHELBY COUNTY. CC750392 (4Qo) Shelby Supply (Rev. 11106) r VOUCHER NO. WARRANT NO. Shelby Materials ALLOWED 20 IN SUM OF P.O. Box 242 Shelbyville, IN 46176 $696.96 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1207 378462 42- 389.00 $696.96 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 Monday, October 11, 2010 Director, Brookshi Golf Club 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)) 09/30/10 378462 Sand $696.96 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