205998 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 365921 Page 1 of 1
ONE CIVIC SQUARE ST REGIS CULVERT INC
CARMEL, INDIANA 46032 202 MORRELL ST CHECK AMOUNT: $96.22
y..' CHARLOTTE MI 48813 CHECK NUMBER: 205998
CHECK DATE: 1/3112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
206 R4237001 21378 92979 96.22 STORM SEWER MAINT SUP
ST
EIS INVOICE
202 Morrell St Charlotte, MI 48813 517 543 -3430
C U L V E R T I N C
Page: 1
Printed By: JENNIFER KNOLL
BILL TO SHIP TO
CARMEL STREET DEPT CARMEL STREET DEPT
3400 WEST 131 ST 3400 WEST 131 ST
CARMEL, IN 46074 CARMEL, IN 46074 USA
Tele: 317 733 -2001 Fax: Ship: C/T; Acnt ID: 71867
Order ID Order Date Tax Code Account Manager Your PO Warehouse
92979 01/05/12 TAX EXEMPT GARY LATHAM INDIANAPOLIS PLANT
Part Number Product Name um Qty Ord Qty Ship Qty BO Sell Extended Tx
RB3612 3e' ANNULAR BAND 1 FT EA 2 2 0 $48.11 $96.22 2
36" ROD
Special Instructions
Discounts Total Before Tax Tax Freight Invoice Total Balance Due
0.00 $96.22 0.00 0.00 $96.22 $96.22
Balance Due: 0210412012
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))
01/05/12 92979 $96.22
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 N
ALLOWED 20
St. Regis Culvert Inc.
IN SUM OF
202 Morrell St.
Charlotte, MI 48813
$96.22
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
21378 92979 42- 370.01 $96.22 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
Thursday „January 26, 2012
Street Commissioner'
Cir'r C:rmmi�cir�n -r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund