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195428 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1 0 ONE CIVIC SQUARE GENERAL SHALE BRICK CHECK AMOUNT: $75.20 CARMEL, INDIANA 46032 PO BOX 71917 CHICAGO IL 60694 -1917 CHECK NUMBER: 195428 CHECK DATE: 3/16/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4236100 181388555 75.20 SAND General Shale Brick =�WMMMZ Building The American Dream Irllr ©�c Invoice: 181388555 Invoice Date: 03/08/2011 Bill To: 279670 Customer P0: shop CITY OF CARMEL 3400 W 131ST STREET Bill of Lading: 171556451 WESTFIELD IN 46074 -8267 Goods Issue Date: 03/08/2011 Order: 313081530 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 6099001047 ESSROC BRIXMENT GRAY S 5 BAG 8.10 40.50 6099008469 50 LB, OF SAND 10 BAG 3.47 34.70 Subtotal 75.20 TAX. TOTAL 75.20 LATE PAYMENT CHARGE of 1.5o PER MONTH_ PLEASE RETURN THIS PORTION WITH YOUR PAYMENT Accnt Customer Name Invoice -Date Invoice Amount Due 279670 CITY OF CARMEL 03/08/2011 181388555 75.20 Remit To: GENERAL SHALE BRICK, INC PO Box 5825 CAROL STREAM IL 60197 -5825 Terms: Take discount of $1.50 If paid an or before 04/07/2011 NET 45 DAYS. V NO. WARRANT NO. ALLOWED 20 General Shale and Brick IN SUM OF P. O. Box 71917 Chicago, IL 60694 -1917 $75.20 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO41 Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 181388555 42- 361.00 $7520 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 i Frid arch 11, 2011 Street Commis ner 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)) 03/08/11 181388555 $75.20 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