167401 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: 355635 Page 1 of 1
1 ONE CIVIC SQUARE MIKE'S EXPRESS CAR WASH
CARMEL, INDIANA 46032 10251 HAGUE ROAD CHECK AMOUNT: $750.00
INDIANAPOLIS IN 46256 CHECK NUMBER: 167401
CHECK DATE: 12/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
1110 4351100 18992 750.00 EXPRESS CAR WASH TICK
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Mike's Carwash, Inc.
10251 Hague Road
Indianapolis, IN 46256
(317) 572 -9250 fax (317) 572 -9251
INVOICE
Customer
Name City of Carmel Police Department Date 12/15/2008
Address 3 Civic Square Order No.
City Carmel State IN ZIP 46032 Rep
Phone 317 571 -2559 FOB
Qty Description Unit Price TOTAL
25 Express Books $30.00 $750.00
SubTotal $750.00
Payment Details Shipping Handling
O Cash Taxes State $0.00
QQ Check
Q Credit Card TOTAL $750.00
Name
CC Office Use Only
Expires
Payment is due upon receipt
INDIANA RETAIL TAX EXEMPT PAGE .I' s l CERTIFICATE NO. 003120155 002 0 1 of i
City li c 1� arm PURCHASE ORDER NUMBER
't Police Deparfameait FEDERAL EXCISE TAX EXEMPT
35- 60000972 18992
HP- NURCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
December 10, 2008 car gash tickets
VENDOR Mike's Carwash, Inc SHIP City of Carmel Police Department
10251 N. Hagge Road TO 3 Civic Sgasee
Indianapolis, IN 46256 Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
25 books Express car wash ticketws 30.00 750.00
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City of Carmel Pow
Send Invoice To:m
ATTN: Teresa Anders
3 Civic Square'
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 511 car clastAgg PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 CLERK-TREASURER
DOCUMENT CONTROL NO A. A. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.._-------- WARRANT NO,.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
�i
Board Members
PO# or PT. INVOICE NO. ACCT #/TITLE AMOUNT I 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
20
Signature
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
Mike's Carwash Inc. Purchase Order No. 18992F
10251 hague ^Road Terms
Indianapolis, IN 46256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/15/08 payment for car wash tickets 750.00
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
M ike's Car wash, Inc.
IN SUM OF
10251 Hague Road
Indianapoiis, IN 46ZJ6
750.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
18992F 511 750.00 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
December 16 20 08
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund