178219 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 361252 Page 1 of 1
ONE CIVIC SQUARE INDY CLEAN TEAM LLC
CARMEL, INDIANA 46032 Po Box 4261 CHECK AMOUNT: $360.00
o� CARMEL IN 46082 CHECK NUMBER: 178219
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350600 .360.00 CLEANING SERVICES
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SOB M09CE
W clean Team, LU
317- 810 -0771
P.O. Box 4251
Carmel, IN 46082
DAT� D E ORDER TAKEN BY
TO PH ONIE NO. CUSTOMER ORDER
ADDRESS JOB LOCATION
JOB PHONE STARTING DATE
ATTENTION TERMS
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WORK ORDERED BY
TOTAL LABOR
DATE ORDERED
TOTAL MATERIALS
DATE COMPLETED
TOTAL MISCELLANEOUS
SUBTOTAL
CUSTOMER APPROVAL
SIGNATURE TAX
AUTHORIZED SIGNATUR GRAND TOTAL
;:adams NC2817
D OB VOOCE
I
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
6, ZI�L o _5 Terms
�,y 2 /6 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 3&o, on
I 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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
C EC 9 1
1,20
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. i hereby certify that the attached invoice(s), or
J -cam Q,Ob 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
Or 20
A /��2
Sig ature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund