179192 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 361032 Page 1 of 1
ONE CIVIC SQUARE DYNA SYSTEMS
CARMEL, INDIANA 46032 P o Box 971342
CHECK AMOUNT: $253.46
DALLAS TX 75397 -1342 CHECK NUMBER: 179192
CHECK DATE: 11/1112009
DEPARTMENT ACCOUNT P N UMBER IN NUMBER AMOUNT D ESCRIPTION
207 4238900 20310654 253.46 OTHER MAINT SUPPLIES
Dyna Systems SHIP TO Invoice
P.O. Box 655326 FBROOKSHIRE GOLF CLUB
Dallas, TX 75265 -5326
(800) 336 -0450 RUSSEL PICKETT 1 of 1
12120 BROOKSHIRE PKWY
t
NCH Corporation C CARMEL, IN 46033
90p1 Accr,P
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BILL TO REMIT TO: PO BOX 971342 o
BROOKSHIRE GOLF CLUB DALLAS TX 75397 -1342 ,cd �eNutnb e 9
BOB H IGGINS "Distribution services include shipping and handling
12120 BROOKSHIRE PKWY charges. Returned merchandise not accepted without
CARMEL IN 46033 return goods authorization. All return claims for errors
or adjustments of any kind must be made within 15
days after receipt of goods.
INVOICE INVOICE DATE CUSTOMER CUSTOMER P/0 DUE DATE
20310 10/29/09 DY305 RUSSEL 11/28/09
ORDER SHIP DATE SALES REP RELEASE SHIP VIA
20260573 -_1_ 70129/09 D202 D202!6287 FED EX GROUND
FOR REORDERS CALL 1- 800 336 -0450 FAX 1- 972 721 -6870
PART:E10 DESC.Rip 1dNJS..12E, I�KG QT`C;BJO EI1°Y SHP.. UNi PRICE."
DY00421329 CAP SCREW SIX SHOOTER EA 0 50 11.38
DY03021300 WASHER FLAT USS DOMESTIC EA 0 100 10.10
DY03481300 WASHER SPLIT LOCK EA 0 100 4.60
DY00421733 CAP SCREW SIX SHOOTER EA 0 50 15.78
DY00421747 CAP SCREW SIX SHOOTER EA 0 50 24.10
DY00421745 CAP SCREW SIX SHOOTER EA 0 50 20.78
DY03482100 WASHER SPLIT LOCK EA 0 100 9.80
DY03481700 WASHER SPLIT LOCK EA 0 100 6.70
DY01982100 NUT GR8 HEX USS USA /CAN M EA 0 100 28.18
DY03022900 WASHER FLAT USS DOMESTIC EA 0 50 15.11
DY01982900 NUT GR8 HEX USS USA /CAN M EA 0 25 13.52
DY40100540 GREASE FITTING BALL EA 0 10 10.75
DY40100542 GREASE FITTING BALL EA 0 10 10.75
DY41350120 FUSE AUTO YELLOW EA 0 10 13.85
DY42511345 PIN CLEVIS EA 0 10 14.02
DY20038500 BUTT CONNECTOR YEL NYLON EA 0 50 26.69
SUB -TOTAL DISCOUNT MIN ORDER CHG SALES TAX *SHIPPING TOTAL
236.11 1 0.00 17.35 AMOUNT 253.46
TO INSURE PROPER CREDIT, PLEASE DETACH HERE AND MAIL BOTTOM PORTION WITH YOUR PAYMENT.
i
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
1
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
n Purchase Order No.
R� 7 �`���Z Terms
9 Date Due
Invoice Invoice Description Amount
Date Number (or no attached invoice(s) or bill(s))
/D o 2 0'sl mq ass.
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
-VOUCHER NO. WARRANT NO.
ALLOWED 20
M S IN SUM OF
7-s35�7 /Y a
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. N I hereby certify that the attached invoice(s), or
1,26 D /vG�S" �Z5 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
i
f'(
f
o 20 Cd
Cost distribution ledger classification if T tle
claim paid motor vehicle highway fund