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161338 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 079150 Page 1 of 1 ONE CIVIC SQUARE DONLEY SAFETY CHECK AMOUNT: $176.21 CARMEL, INDIANA 46032 P O BOX 33396 INDIANAPOLIS IN 46203 CHECK NUMBER: 161338 CHECK DATE: 7/11/2008 DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION 1120 4237000 19289 176.21 REPAIR PARTS i I D ORLEY INVOICE Mw Please visit us on the web at www.don /eysafety.coin 1718 VILLA AVE. Phone 317- 786 -2268 Date Invoice P.O. BOX 33396 Fax 317- 786 -2532 INDIANAPOLIS, IN, 46203 6/20/2008 19289 Bill To Ship To CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT 2 CIVIC SQUARE_ 2 CIVIC SQUARE CARMEL, IN. 46032 CARMEL, IN. 46032 P.O. Number Terms Salesperson Ship Via F.O.B. Order Date Net 30 DG WILL CALL Ordered Shipped B/o Item Number Description Unit Price UOM Ext. Price 2 2 0 110527 3/4" AIR DRAIN ASSEMBLY 84.50 169.00 1 1 0 S- IN130UND INBOUND FRI IGI IT FOR SPECIAL 7.21 721 ORDER ITEM Sales Tax (7.0 $0.00 PRICE DISCREPANCIES, RETURN REQUESTS OR Total SHIPMENT ERRORS MUST BE REPORTED WITHIN 30 $176.21 DAYS TO RECEIVE,CREDIT. Questions about this invoice? Please call 3'17- 786 -2268. Prescribed by State Board of Accounts City Form No. 201 (F3ev. 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)) 06120/08 19289 Drain Assembly Stock $176.21 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 VOUC'NER NO. WARRANT NO, ALLOWED 20 Donley Safety IN SUM OF P.O. Box 33396 Indianapolis, IN 46203 $176.21 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members 1120 19289 42- 370.00 $176.21 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 1 Title Cost distribution ledger classification if claim paid motor vehicle highway fund