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Home My WebLink About199493 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 119835 Page 1 of 1 ONE CIVIC SQUARE HAMILTON COUNTY CO -OP INC CARMEL, INDIANA 46032 PO BOX 1106 CHECK AMOUNT: $1,803.53 huh c NOBLESVILLE IN 46061 CHECK NUMBER: 199493 CHECK DATE: 7/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4231300 GT 019711 1,803.53 DIESEL FUEL SALE 2387 DATE 07/07/11 14:31:48 COUNT: START 0.0 END 250.4 GROSS DELIVERY 250.4 GALLONS 4017 UNLEADED GAS UN GASOLINE 1 MULTIPLE DELIVERIES AT SITE SALE 4814 DATE 07/07/11 14:27:12 COUNT: START 0.0 END 298.7 GROSS DELIVERY 298.7 GALLONS 4040 DIESELEX ULS UN DISTILLATI MULTIPLE DELIVERIES AT SITE HAMILTON COUNTY CO -OP i PO BOX 1.106 NOBLESVILLE, IN 46061 CHARGE INVOICE Driver:. GT•- :.GARY TEETERS Custoner 028761 Invoice GT 019711 BRO049HIRE.GOLF CLUB Date: 7/7/2011 CITY OF CARMEL Tim 14:26 12120 BROOKSHIRE PKWY CARMEL, IN 46033 Tras Teras Description Iteo Description Legend Quantity Unit Price Ite© Total 01 NORMAL 104817 UNLEADED GAS GOV'T E 250.3000 3.01000 753.40 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 (I.V.D.) ADDITIVE. CONFORMS TO REQUIREMENTS FOR A 9.0 P.S.I MAX. RVP GASOLINE DURING THE MONTHS OF MAY 1ST THROUGH SEPTEMBER 15TH. State Road Tax 0.18000 45.05 01 NORMAL 154040 DIESELEX ULS UN 19 E 298.7000 3.42M 1021.5; 01 NORMAL 194070 PETRO VOLUME DISCOUN a 549.0000 0.03000 -16.47 Legend: Invoice Subtotal: 1,803.53 E= Metered, T= Taxable, *=Entered by Hand Indiana Sales Tax 1: 0, 0.00 Invoice Total: 1,803.53 U WARNING PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING IRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-860- 424 -9300 WE APPRECIATE YOUR BUSINESS!!! i Prescribed by State Board of Accounts City Form No. 241 (Rev. 199° 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)) 07/07/11 GT 019711 Fuel $1,803.5 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 Hamilton County CO -OP IN SUM OF P.O. Box 1106 Noblesville, IN 46061 $1,803.53 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1207 GT 019711 42- 313.00 $1,803.53 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 Tuesday, July 12, 2011 I Director, Broo ire Golf Club Title Cost distribution ledger classification if claim paid motor vehicle highway fund