198094 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
ONE CIVIC SQUARE GENERAL SHALE BRICK
CARMEL, INDIANA 46032 PO BOX 5825 CHECK AMOUNT: $10.70
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CAROL STREAM IL 60197 -5825 CHECK NUMBER: 198094
CHECK DATE: 6/612011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 181430539 10.70 OTHER MAINT SUPPLIES
General Shale
Bricks�m����=�
Building The American Dream
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Invoice: 181430539 Invoice Date: 05/24/2011
Sill To: 279670 Customer P0: street department
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 171604001
WESTFIELD IN 46074 -8267 Goods Issue Date: 05/24/2011
Order: 3134 05269
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
6099000695 VERSA -LOK CONCRETE ADHESIVE 2 EA 5.35 10.70
Subtotal 10.70
TAX
TOTAL 10.70
LATE PAYMENT 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 05/24/2011 181430539 10.70
Remit To: GENERAL SHALE BRICK, INC
PO Box 5825
CAROL STREAM IL 60197 -5825
Terms: Take discount of $0.21 If paid on or before 06/23/2011 NET 45 DAYS.
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))
05/24/11 181430539 $10.70
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
VOUCHER NO. WAR NO.
ALLOWED 20
General Shale and Brick
IN SUM OF
P. O. Box 5825
Carol Stream, IL 60197 -5825
$10.70
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Member;
2201 181430539 42- 389.00 $10.70 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
Wedne§da&ne 01, 2011
ua"
S Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund