201205 09/13/2011 a CITY OF CARMEL, INDIANA VENDOR: 092000 Page 1 of 1
ONE CIVIC SQUARE FASTENAL COMPANY
CHECK AMOUNT: $331.66
CARMEL, INDIANA 46032 Po eox lzas
•c WINONAMN 55987 -1286 CHECK NUMBER: 201205
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4238900 ININ85457 331.66 OTHER MAINT SUPPLIES
Remit to INVOICE
Fastenal Company
P.O. Box 1286 Page 1 of 1
Winona, MN 55987 -1286
Date Invoice No.
ININ80083 For billing questions 08/24/2011 ININ85457
Cust. No.
Cust. P.O. ININ8 430 Alpha Drive, Suite 300
WESTFIELD, IN 46074 Due Date Invoice Total
Job No.
Contract No. QPA 11179 United States Phone 317 867 -5259 09/23/2011 331.66 USD
Fax 317 867 -5394
Sold To
0005213 01 AB 0.368 "AUTO T6 1 1051 46032- 7.05213
Ship To
CARMEL CLAY PARKS RECREATION CARMEL CLAY PARKS RECREATION
1411 E 116TH ST 1411 E. 116TH ST.
CARMEL, IN 46032 -7611 CARMEL, IN 46032
This Order and Document is subjeci to the T errri5 oi'Purci lase" postsd or, w 1as.anaI.zom:
Line Quantity Quantity Quantity Control Part Price
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 12 12 0 20X20X1StdCapPltFltr 120117074 0400033 232.2000 27.86 Y
2 12 12 0 9X31X1 AIR FILTER WEIN0671 SP -102- 041 -299 505.0000 60.60
3 12 12 0 25x20x5MERV8KOCHAB WEIN0671 0473017 1,533.9000 184.07 Y
4 12 12 0 20X2OX4StdCapPItFItr 120113829 0452046 492.7500 59.13 Y
Purchase p Description Al P, FILT><C�� ,v�, A'^ a��
P.O.
__�e8 i Poe X 1CJ SEP Q 1 7n11
G.L. �I�� OZ- y231�J�
Budget
Line Descr
Purchaser
Date________
Approval
Date
Received By Tax Exemption Subtotal 331.66
0119683083 -001 G Shipping Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact: SERRA GRANSKE City Tax 0.00
Total 331.66
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re- package or re -sell this product, you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
0005213 -01- 0015678 Invoice: ININ85457 Cust: ININ80083
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
092000 Fastenal Company Terms
P.O. Box 1286
Winona, MN 55987 -1286
Invoice Invoice Description,
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8124111 ININ85457 Air filters 28816 331.66
Total 331.66
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,
092000 Fastenal Company Allowed 20
P.O. Box 1286
Winona, MN 55987 -1286
In Sum of
331.66
ON ACCOUNT OF APPROPRIATION FOR
101 General Fund
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1125 ININ85457 4238900 331.66 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
8 -Sep 2011
Signature
331.66 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund