191111 10/27/2010 F CITY OF CARMEL, INDIANA VENDOR: 358201 Page 1 of 1
ONE CIVIC SQUARE ASHBROOK SIMON HARTLEY CHECK AMOUNT: $1,166.35
CARMEL, INDIANA 46032 PO BOX 974343
DALLAS TX 75397 -4343 CHECK NUMBER: 191111
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 112937 1,166.35 OTHER EXPENSES
Ashbrook Simon-Hartley Operations, LP Phone: 800 -362 -9041
11.600 East Hardy Road Fax: 281 -449 -1324
fic ston Texas 77093
USA
Invoice: 112937 g i I; 0410 Page: 1 of 1
Date: 9/30/2010
Sold To: To:
CITY OF CARMEL CARMEL WWTP SEWER DEPARTMENT
UTILITIES 9609 HAZELDELL PARKWAY
760 3RD AVE SW SUITE 110 INDIANAPOLIS IN 46280
CARMEL IN 46032 USA
USA
30 7058'
PO Number: S12291 Terms: NET 30 DAYS F.O.B: ORIGIN
'Sales Rep: JOYCE MUL.FORD Ordered: 9/30/2010 Ship Via: BESTWAY
Packing Slip: 12808 Ship Date: 9/30/2010
ATTN: ,IEFF COOPER, MAINTENANCE FOREMAN
T-
T 317- 571 -2634 X 222
i
THANK YOU FOR YOUR ORDER. IF YOU HAVE ANY QUESTIONS, CONTACT r !f Yr✓r MC.1 FORD AT
3
ALL AMOUNTS, SHOWNIN,lr.S. DOLLARS
1 1,.01:1 -070572 975.0& EA 975:00
BELT,3.2M X9.690M 8065 3.2M WIDE X9.690M LONG
STYLE 8065 36LL SEAM ABE 3.0 METER
War ehouse Code: WH
Line (1) Miscellaneous Char_ge.s
Description Amount
1.) FREIGHT OUT 191 -35
PaYrnert Schedule Total: 1,166.35 USD
.Amount
1 10/ 30/2010 1 Remit To:
Total 1,166 -35 Ashbrook Simon Hartley
P.O. Box 974343
Dallas, TX 75397 -4343
Invoice: 112937
ARForwo01'00
Vr)UCHER 106407 WARRANT ALLOWED
k
358201 IN SUM OF
ASHBROOK SIMON HARTLEY
PO BOX 974343
DALLAS, TX 75397 -4343
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
112937 01- 7202 -06 $1,16625
Voucher Total $1,166.35
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
358201
ASHBROOK SIMON HARTLEY Purchase Order No.
PO BOX 974343 Terms
DALLAS, TX 75397 -4343 Due Date 10/18/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/18!201( 1-12937 $1,166.35
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