156764 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 00350268 Page 1 of 1
ONE CIVIC SQUARE PEERLESS MIDWEST INC
CARMEL, INDIANA 46032 55860 RUSSELL INDUSTRIAL PARKWAY CHECK AMOUNT: $103.40
MISHAWAKA IN 46545 CHECK NUMBER: 156764
CHECK DATE: 2/2112008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DE
601 5023990 22197 103.40 MATERIALS SUPPLIES
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Peerless Midwest Inc.
55860 Russell Industrial Parkway Mishawaka, Indiana 46545 1 574 254 -9050 Fax 574 254 -9650
Federal ID 35- 1284374
8135 INVOICE NO. Vendor#
City of.Carmel Utilities 22197
SOLD TO Accounts Payable TERMS- NET 30 DAYS. 1.5% SERVICE CHARGE (18% ANNUAL RATE) EACH
130 First Avenue SW MONTH THEREAFTER
Carmel IN 46032 Invoice Date Proj Mgr.
8/29/2007 TTH
S. O. No. Your Order No.
21138 Rob Lovell
Tax Exempt? Reason Tax Exempt
SHIP TO 14 Plant #5 Yes No
P.I. Sub.
Labor Cost Material Cost Tax
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Material
1 10" Blind flange
TOTAL AMOUNT OF THIS INVOICE 103.40
'FILE: 15770
Prescribed by State Board of Accounts City Form No. 201 (Rev 1 X
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
Zs
price per unit, etc.
Payee
350268
PEERLESS MIDWEST, INC Purchase Order No.
55860 RUSSELL INDUSTRIAL PARKWA Terms
MISHAWAKA, IN 46545 Due Date 12/31/2007
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/31/200 22197 $103.40
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
a //S h2 Y
Date Officer
VOUCHER 074636 WARRANT ALLOWED
3 °0268 IN SUM OF
PEERLESS MIDWEST, INCA
r• 55860 RUSSELL INDUSTRIAL P V'
MISHAWAKA, IN 46545
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
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Board members
A90N
PO I V# ACCT AMOUNT Audit Trail Code
22197 01- 6200 -02 $103.40
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P
1
1
17
Voucher Total $103.40
Cost distribution ledger classification if
claim paid under vehicle highway fund