159901 05/28/2008 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1
\y ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC
CARMEL, INDIANA 46032 PO BOX 1106 CHECK AMOUNT: $4,054.77
NOBLESVILLE IN 46061 CHECK NUMBER: 159901
CHECK DATE: 5/28/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4231300 012262 2,783.96 DIESEL FUEL
905 4231300 012377 1,270.81 DIESEL FUEL
STATEMENT
mm t Grain Merchandising 773 -2685 Amount
O a111i 1.0� C oun Grain Terminal 773 -2599 Enclosed:
Horton 758 -4463 PACE 1
COOPERATIVE ASSOCIATION, INC Noblesville Petroleum /Plant Food 776 -4143 04/30/08
SEND WQUIRIES TO:
PO 1106 •Noblesville, Indiana 46061 PAY THIS AMOUNT $4,054.77
(317) 773 -0870 Fax (317) 776 -4149
J
0000028761 BROOKSHIRE GOLF CLUB CUSTOMERS IN TIPTON AND ATLANTA CAN NOW CALL TOLL FREE
CITY OF CARMEL THE NEW NUMBER IS 765 675 -2538
12120 BROOKSHIRE PKWY
CARMEL IN 46033
L PLEASE RETURN THIS PORTION WITH REMITTANCE
_03, 31, 08 BALANCE FORWARD .00
04/08/08 012262 010 INVOICE 2,783.96 2,783.96
527.4000 GAL UNLEADED GAS 3.2640 1721.43
300.8000 GAL DIESELEX ULS 3.6700 1103.94
828.2000 -EA PETRO VOLUME DISCOU .0500 41.41-
04/25/08 012377 010 INVOICE 1,270.81 4,054.77
227.0000 GAL UNLEADED GAS 3.5140 797.68
126.3000 GAL DIESELEX ULS 3.8300 483.73
353.3000 -EA PETRO VOLUME DISCOU .0300 10.60
n V
C
CREDITTERMS ENTIRE ACCOUNT IS SUBJECT TO AGED ANALYSIS OF BALANCE
000PER MONTH ANNUAL RATE .00% CURRENT 1 -30 DAYS 1 31 90 DAYS OVER 90 DAYS
FINANCE CHARGE OF 05/31/08
IF PAYMENT N T RE EIVED BY
EXPLANATIONS:
1. The monthly period is from the first day of the month to the last day of the month,
2. "Payment now due" is the portion of the total that will be due on or before the due
date. Any account not paid by this date is considered "past due".
NOTICE TO CUSTOMER: If you pay the New Balance on or before the Due Date
there will not be a finance charge.
A Finance Charge will be added when the account becomes past due. The due date
or time period of the credit terms is on the fto side of this statement. To avoid a
FINANCE CHARGE, the Payment Now Due must be received on or before Due Date.
FINANCE CHARGE is computed by using the Periodic Rate (per month) applied to
amount past due as of the closing date, or the Minimum Finance Charge, as shown.
The Annual Finance Charge rate is shown in the Annual Rate box. The finance
charge is made as of the closing date.
IN CASE OF ERRORS OR INQUIRIES ABOUT YOUR BILL: Send your written inquiry
to the address shown on the front of this statement so that we receive it within 60 days
after the bill was mailed to you. Your written inquiry must include: 1. Your Name and
Account Number (if any): 2. A Description of the Error; and 3. The Dollar Amount of
the Suspected Error. You remain obligated to pay the parts of the bill not in dispute.
During that same time, we may not take any action to collect disputed amounts or
report disputed amounts as delinquent.
This is a summary of your rights; a full statement of your rights and the creditor's
responsibilities under the Federal Fair Credit Billing Act will be sent to you both upon
request and is response to a billing error notice.
SALE 8927 DATE 04/08/08 09:09:16
COUNT: START 0.0 END 301.0
GROSS DELIVERY 301.0 GALLONS
4040 DIESELEX ULS DISTILLATI
J
MULTIPLE DELIVERIES AT SITE
SALE 4736 DATE 04/08/08 09:11:12
COUNT: START 0.0 END 527.4
GROSS DELIVERY 527.4 GALLONS
4017 UNLEADED GAS GASOLINE I
MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO -OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000028761 Invoice GT 012262
BROOKSHIRE GOLF CLUB Date: 4/8/2008
CITY OF CARMEL Time: 09:22
12120 BROOKSHIRE PKWY
CARMEL, IN 46033
Tras Terns Description Item Description Legend Quantity Unit Price Item Total
01 NORMAL 104017 UNLEADED GAS E 527.4000 2.90000 1529.46
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REQUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC
(I.V.D.) ADDITIVE. CONFORMS TD REQUIREMENTS FOR A 9.0 P.S.1 MAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST
THROUSH SEPTEMBER 15TH.
Federal Road Tax 0.1849 97.04
State Road Tax 0.18000 94.93
01 NORMAL 154040 DIESELEX ULS E 300.8000 3.67000 1103.94
01 NORMAL 194070 PETRO VOLUME DISCOUN E 828.2000 0.05000 -41.41
Legend: Invoice Subtotal: 2783.96
E--Metered, T= Taxable, entered by Hand Sales Tax On: 0.00 0.00
Invoice Total: 2783.96
WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1- 800 424-9300 WE
APPRECIATE YOUR BUSINESS!!!
a
i
SALE 9021 DATE 04/25109 09:40:04
t COUNT: START 0.0 END 126.4
GROSS DELIVERY 126.4 GALLONS
4040 DIESELEX ULS DISTILLATI
f
MULTIPLE DELIVERIES AT SITE
SALE 4803 DATE 04/25/08 09:42:4.7
COUNT: START 0.0 END 227.0
GROSS DELIVERY 227.0 GALLONS
4017 UNLEADED GAS GASOLINE 1
MULTIPLE DELIVERIES AT SITE
HAMILTON COUNTY CO—OP
PO BOX 1106
NOBLESVILLE, IN 46061
CHARGE INVOICE
Driver: ST GARY TEETERS
Customer: 0000028761 Invoice GT 012377
BROOKSHIRE GOLF CLUB Date: 4/25/2008
CITY OF CARMEEL I Time: 09 ;46
12120 BROOKSHIRE PKWY
CARMEL, IN 46033—
Tras Terms Description Iten #t Description Legend Quantity Unit Price Iteo Total
01 NORMAL L 104017 UNLEADED GAS E 227.0000 3.15000 715.05
WARNING CONVENTIONAL GASOLINE THIS PRODUCT DOES NOT MEET THE REQUIREMENTS FOR REFORMULATED GASOLINE AND MAY NOT BE
USED IN ANY REFORMULATED GASOLINE COVERED AREA. THIS PRODUC T CONTAINS PRESCRIBED LEVELS OF INTAKE VALVE DETERGENT
USED IN ANY REFORMULATED GASOLINE COVERED AREA, THIS PRODUC
(I.V.D.) ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P.S.1 MAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST
THROUGH SEPTEMBER 15TH.
Federal Road Tax 0.18400 41.77
r State Road Tax 0.18000 4
01 NORMAL_ 154040 DIESELEX ULS E 126.3000 3.83000 483.73
01 NORMAL 194070 PETRO VOLUME DISCOUN 353.30@0 0.03000 —10.60
Legend: Invoice Subtotal: 1270.81
E= Metered, T= Taxable, Entered by Hand Sales Tax On: @.00 0.00
Invoice Total: 1270.81
WARNING PETROLEUM PRODUCTS NOT TO BE LGED FOR STARTING OR KINDLING FIRES.. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPDSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1 -800- 424 -939 WE
APPRECIATE YOUR BUSINESS!!!
i
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
119835 Purchase Order No.
Hamilton County Co -op
PO Box 1106 Terms.
Noblesville IN 46060
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
ids �/a 3 l -Z7o•
Total 1710 S
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. WARRANT NO.
ALLOWED 20
119835 IN SUM OF
Hamilton County CO-OP
PO Box 1106
Noblesville IN 46060
posy 7 7
ON ACCOUNT OF APPROPRIATION FOR
4& e6f c
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
gOS p /�,7 Ga 3/,3 �7d'3, ro bill(s) is (are) true and correct and that the
77 3/3 Z X70. materials or services itemized thereon for
which charge is made were ordered and
received except
20 OS
Si g7 d
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund