HomeMy WebLinkAbout155268 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00350687 Page 1 of 1
ONE CIVIC SQUARE DICK HILL
CARMEL, INDIANA 46032 CHECK AMOUNT: $19.27
CHECK NUMBER: 155268
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4342100 19.27 POSTAGE
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BOXFRM -01 (10/06)
CO DEPT DAT� NO
PACKAGE SHIPPING REQUEST
COMPANY
616 Station Drive E STR T ADDRE$ S
Carmel, In 46032 N l_ I U C C- �C'
D CI ZIP �j
R OMEPHONE,WORKPHONE
(317) 846 -7467 FAX (317) 846-7468 1
Internet http: /www.boxco.com q6 �7 >I� S3 -9� 1 1 4 j�
PKG SEND TO DESCRIPTION OF DIE av�ER sDo VALUE
NO p PACKAGE CONTENTS YOU WANT ADVLINS
NA 12' WC2
Lei C PKG WT CARRIER
lJJ CHARGES
1 TREET ADDRESS i��,�t ADDITIONAL
i 00. K) ��A L IJ 808 L •`a .C. f�. ZONE INSURANCE
CITY, STATE, ZIP
1 fJ O n U OL1 i t (a HANDLING
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NAME PKG WT CARRIER
CHARGES
2 STREET ADDRESS �j ADDITIONAL
ZONE INSURANCE
CITY, STATE, ZIP
HANDLING
CHARGE
NAME PKG WT CARRIER
CHARGES
3 STREET ADDRESS e-�
ADDITIONAL
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CITY, STATE, ZIP IWT$
HANDLING
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NAME CARRIER
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w STREET ADDRESS 4 ADDITIONAL
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CITY STATE, ZIP HANDLING
CHARGE
ATTENTION CUSTOMERS!!
PLEASE COMPLETE ALL WHITE AREAS ON THIS FORM. TOTAL
PLEASE DECLARE THE VALUE OF THE PACKAGE(S) YOU ARE SHIPPING IF YOU INTEND TO PURCHASE INSURANCE TO COVER CHARGE
A PACKAGE WHICH HAS A VALUE OVER THE CARRIER'S LIMITED $100 LIABILITY. MAXIMUM COVERAGE CANNOT EXCEED
$25,000 IN VALUE.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITYOF 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
Dick Hill
Purchase Order No.
Engineering Department
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/27/07 n/a Mailing to INDOT: Annual Road Inventory $19.27
Total
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Dirk Hill IN SUM OF
Engineering Department
$19.27
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or DEPT INVOICE NO. ACCT /TITLE AM I hereby certify that the attached invoice(s), or
n/a n/a EN 4342100 $19.27 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
e received except
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20 AQ
Si na ure
Titl
Cost distribution ledger classification if
claim paid motor vehicle highway fund