205172 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 092000 Page 1 of 1
ONE CIVIC SQUARE FASTENAL COMPANY
CARMEL, INDIANA 46032 PO BOX 1286 CHECK AMOUNT: $170.36
WINONA MN 55987 -1286 CHECK NUMBER: 205172
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239032 ININ86630 170.36 POSTS HARDWARE
i
ANN Remit to
PASIBW Fastenal Company INVOICE
P.O. Box 1286 Page 1 of 1
Winona, MN 55987 -1286
Date Invoice No.
Cust. No. ININ80003 For billing questions 12/21/2011 ININ86630
Cust. P.O. Jeff Stewart -WC 430 Alpha Drive, Suite 300
Job No. 317 417 -5053 WESTFIELD, IN 46074 Due Date Invoice Total
Contract No. QPA 11179 Phone 317 -867 -5259 01/20/2012 170.36 USD
Fax 317 867 -5394
Sold To
0004654 01 A80.368 "AUTO H6 0 1076 46074 -8 -04854
Ship To
CARMEL STREET DEPT. CARMEL STREET DEPT.
3400 W 131 ST ST 4K 3400 W 131 ST ST
WESTFIELD, IN 46074 -8267 WESTFIELD, IN 46074
This Order and Document is subject to the "Terms of Purchase" posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 1 1 0 ADB FAST -LOK TOOL WEIN0784 12728 -00224 16,240.0000 162.40
Received By Tax Exemption Subtotal 162.40
0031201550 -020 G Shipping Handling 7.96
IN State Tax 0.00
Comments County Tax 0.00
Contact: Jeff Stewart City Tax 0.00
Total 170.36
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.
0004854 01.0014885 Invoice: ININ86630 Cust: ININ80003
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/21/11 ININ86630 $170.36
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.
ALLOWED 20
Fastenal
IN SUM OF
P. O. Box 978
Winona, MN 55987 0978
$170.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 ININ86630 42- 390.32 $170.36 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
1 �uesda'' January 03, 2012
v war!
Street Comm`Uioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund