200860 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
ONE CIVIC SQUARE GENERAL SHALE BRICK
CARMEL, INDIANA 46032 PO BOX 5825 CHECK AMOUNT: $199.80
CAROL STREAM IL 60197 -5825 CHECK NUMBER: 200860
CHECK DATE: 8130/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236100 181483035 199.80 SAND
General Shale
ric k W 0 W ME
Building The American Dream
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Invoice: 181483035 Invoice Date: 08/15/2011
Bill To: 279670 Customer P0: 08132011
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 171661385
WESTFIELD IN 46074 -8267 Goods Issue Date: 08/15/2011
Order: 313753170
Sales Rep: 399
Ship -To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074 -8267 Phone: 317- 846 -2566
Mode of Shipment: Customer Pickup 057
Material Material Description Quantity Price Value USD
Batch Number and Description
6099032390 POLYSWEEP POLYMERIC SAND TAN 12 EA 16.65 199.80
Subtotal 199.80
TAX
TOTAL 199,80
LATE PAYMENT CHARGE of 1.5°6 PER MONTH.
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT
Accnt4: Customer Name Invoice -Date Invoice Amount Due
279670 CITY OF CARMEL 08/15/2011 181483035 199.80
Remit To: GENERAL SHALE BRICK, INC
PO Box 5825
CAROL STREAM IL 60197 -5825
Terms: Take discount of $4.00 If paid on or before 09/14/2011 NET 45 DAYS.
VOUCHER NO. WARRANT NO.
ALLOWED 20
General Shale and Brick
IN SUM OF
P. O. Box 5825
Carol Stream, IL 60197 -5825
$199.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 181483035 42- 361.00 $199.80 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
Thursday,fAugust 225, 2011
r
eet.,Commissioner
Street Uommiss,oner
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/15/11 181483035 $199.80
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