206144 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 365925 Page 1 of 1
ONE CIVIC SQUARE BELFOR PROPERTY RESTORATION
CARMEL, INDIANA 46032 6205 MORENCI TRAIL CHECK AMOUNT: $17,637.20
INDIANAPOLIS IN 46266
CHECK NUMBER: 206144
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 R4350100 26257 15737 -1 17,637.20 WASH BAY DEDUCTIBLE
Invoice 15737 -1
Date 2/8/12 (0)
Invoice PROPERTY RESTORATION
Customer: Re:
Name: City of Carmel Street Department Name: City of Carmel Street Department
Address: 3400 W. 131st Street Address: 3400 W. 131st Street
City: Carmel, IN 46074 City: Carmel, IN 46074
Attn: ATTN: Jeff Stewart
DATE QTY U/M DESCRIPTION Unit Price Total
FEDERAL ID 84- 1309171
1.00 Billing for emergency services as per attached '17,637.20 17,637.20
cc: Travelers Insurance Don Mitchell
Sub Total 17,637.20
Total j 17,637.20
All accounts are due upon receipt. There will be a 2% charge
per month after 15 days. All lien rights reserved.
BELFORUSA 6205 Morenci Trail, Indianapolis, IN 46268 888.491.7941 ph: 317.297 -3443 fx: 317.297.3456
24/7 emergency hotline 800 856.3333 www.hetforusa.com
VOUCHER NO. WARRANT NO.
ALLOWED 20
Belfor Property Restoration
IN SUM OF
6205 Morenci Trail
Indianapolis, IN 46268
$17,637.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
26257 15737 -1 43- 501.00 $17,637.20 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
Monday, February 13, 2012
S r et Com A ssid
Street Commissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
02/08/12 15737 -1 $1 7,637.20
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
1 20
Clerk- Treasurer