173719 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 359344 Page 1 of 1
ONE CIVIC SQUARE AYERS BACKFLOW CHECK SERVICE
CARMEL, INDIANA 46032 20 BENNETT ROAD CHECK AMOUNT: $250.00
CARMEL IN 46032 CHECK NUMBER: 173719
CHECK DATE: 6/24/2009
DEP ARTMENT ACCOUNT PO NUMB INVOI NUMBER AMOUN DESCRIPTION
1125 4350000 213558 250.00 EQUIPMENT REPAIRS M
r`�
r� 213558
JUN U 8 2009 I NVOICE
SOLD TO. SHIP PE TO'.'
CAR -^�L
ADDRESS ADDRES
CITY, STATE, ZIP CITY, STATE, ZIP
c-4- 0--p-4 -L e*z'" 6- z
CUSTOMER'S ORDER SALESPERSON TERMS VIA F.O.B: DATE
Ai ✓£2 Vgr,-r e AA4 s Z r2 7347
131 57
rcnase
13A CK RLOvJ 2Cr 9 y3T6` z .r 3�
5€
P 0.0 0 2-2- 7i� Z
Lek D ,1/2/0 r.
8
r°ke,< 116 57
IOY3� yA
7110 rlf-c Ot' 2-S 0:00
v4vn to owl T &Iz -fo (9v Z Qv fc/<
15- m..q c n C, T I F p /32t 0 C27
,F or c y c u o Go
&seder 8140
ACCOUNTS PAYABLE VOUCHER
`Z-
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
359344 Ayers Backflow Check Ser Terms
20 Bennett Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
613109 213558 Backflow preventive test 20814 250.00
Total 250.00
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
Voucher No. Warrant No.
359344 Ayers Backflow Check Ser Allowed 20
20 Bennett Rd
Carmel, IN 46032
In Sum of$
250:00
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1125 213558 4350000. 250.00 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
18 -Jun 2009
Signature
250.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund