174738 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 359344 Page 1 of 1
ONE CIVIC SQUARE AYERS BACKFLOW CHECK SERVICE
CARMEL, INDIANA 46032 20 BENNE77 ROAD CHECK AMOUNT: $270.00
CARMEL IN 46032 CHECK NUMBER: 174738
CHECK DATE: 7/22/2009
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
"1047 4350100 213559 270.00 BUILDING REPAIRS MA
213559
I NVOICE
SOLD TO: SHIPPED TO
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CITY, STATE, ZIP CITY, STATE, ZIP
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CUSTOMER'S ORDER I :SALIE'SPERSON TERMS VIA E. .B. DATE
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Purchaser Uate
Approval T� Date
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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
t. whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
359344 Ayers Backflow Check Ser Terms
20 Bennett Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
613109 213559 Backflow preventive test 22054 F 270.00
Total 270.00
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
1 20_
Clerk- Treasurer
Voucher No. Warrant No.
359344 Ayers Backflow Check Ser Allowed 20
20 Bennett Rd
Carmel, IN 46032
In Sum of
f t
270.00
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #1TITLE AMOUNT Board Members
Dept
1047 213559 4350100 270.00 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
16 -Jul 2009
A J" 04,
Signature
270.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund