177623 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 363350 Page 1 of 1
ONE CIVIC SQUARE CUSTOM CONCRETE CHECK AMOUNT: $3,918.33
CARMEL, INDIANA 46032
CHECK NUMBER: 177623
CHECK DATE: 9129/2009
DEPARTMENT ACCOUNT PO N INVOI N UMBER AM DESCRIPTI
1120 4350900 12684 49121 3,918.33 CONCRETE PAD
I NVOICE
customconas
INVOICE DATE CUSTOMER NO INVOICE NUMBER
P.O. Box 1627 •Indianapolis, IN 46206 -1627
(317) 896 -2885 Fax (317) 867 -1405 09 -23 -2009 31760 49121
www.customconcrete.com
TO: Carmel Fire Dept. JOB SITERiver Rd.
2 Civic Square
Carmel, IN 46032
SALESPERSON TERMS JOB NUMBER P.O. NUMBER
Joe Station 15 D Y
ITEM DESCRIPTION QUANTITY UNIT UNIT PRICE AMOUNT
1 Machine To Strip Cut Pad To Necessary 1.00 amount 175.00 175.00
Elevation
2 Granular Fill In Place 20.41 tons 13.00 265.33
3 Equipment Labor To Compact Underslab 1.00 amount 700.00 700.00
Fill
4 I Curing Sealer. for, Slabs..-.Standa�d 900.00 sq.ft 06 54.00
5 Sawed or Tooled Control Joints Slabs 1.00 amount i 75.00 75.00
6 Slab Forming 136.00 lin.ft 3.00 408.00
7 Engineered Letter 1.00 amount 275.00 275.00
8 I Fibered Concrete Slabs 900.00 I sq.ft .10 I 90.00
9 4" Slab 900.00 I sq.ft 1.89 I 1,701.00
10 Backfill i 1.00 each 175.00. 175.00
I
I I
**PLEASE NOTE** I
OUR "REMIT TO" ADDRESS HAS CHANGED
PLEASE MAIL PAYMENTS TO:
CUSTOM.CONCRETE CO., INC
.17241. FOUNDATION_ PARKWAY
WESTFIELD, IN 46074
Total This Invoice: $3,918.33
Interest in the sum 1% per month, 12% annually,
is charged on all past due accounts, plus costs attorney fees in the event of collection. �7/
Lien rights will be exercised if prompt payment is not received. 1;a12f2 7�OU
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))
49121 $3,918.33
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer
I
VOU NO. WARRANT NO.
,Ji ALLOWED 20
Cu Aom Concrete
1 IN SUM OF$
17421 Foundation Parkway
Westfield, IN 46074
$3,918.33
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
12684 49121 43- 509.00 $3,918.33 I hereby certify that the attached invoice(s), or
HY
bill(s) is (are) true and correct and that the
r
materials or services itemized thereon for
which charge is made were ordered and
ea
fr��= received except
SEP 2 9 2009
r
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund