173199 06/10/2009 CITY OFCARMEL'INDIANA »Ewoon 358798 Page 1 of 1
ONE CIVIC SQUARE AMERICAN CLEAN SEAL
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INDIANAPOLIS IN 462' CHECK NUMBER: 173199
CHECK DATE: Vnum000
ospAnTMswT AcoouwT PO NUMBER INVOICE NUMBER AMOUNT osoompTmw
1205 4462000 3519 750.00 OTHER STRUCTURE ZMPRO
i
AMERICAN CLEAN &SEAL INVOICE
4469 BRAGDON STREET
INDIANAPOLIS, INDIANA 46226
FED. ID. #43- 2014054
(317) 536 -0211
Date: 05/15/09 Inv. No.: 3519
Due Date: 05/25/09 Page No.: 1
Ship To /Remarks
City of Carmel
ATTN: Accounts Payable
One Civic Square
Carmel IN 46032 -2584
REFERENCE TERMS YOUR OUR SALES REP
Net 10 Days PO# W08737 MARK
'DESCRIPTION UNIT ITEM
UNIT PRICE EXTENDE PRICE
DISCOUNT MEASURE
TEST PATCH Pressure Testing 5.0 150.0000 750.00
Pressure tested the supply side of the
plumbing in the fountain tub.
Job Location: City Center 3rd Ave.
Job Completed: 5 -14 -09
Thank You Very Much for your Business
PO# W08737
SUBTOTAL 750.00
TAX 0.00
TOTAL 750.00
NET TO PAY 750.00
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
A merican Clean Seal Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05i i W09 35ig Pressure b
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 N ARRANT NO.
American Clean Seal ALLOWED 20
IN SUM OF
4469 Bragdon Street
nd 415226
$750.00
ON ACCOUNT OF APPROPRIATION FOR
GENERALFUND
1205 Administration
Board Members
PO# or D 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
1205 3519 620 $750. 00 materials or services itemized thereon for
which charge is made were ordered and
received except
20
�%qn tur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund