179283 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 00351017 Page 1 of 1
ONE CIVIC SQUARE KIRBY RISK ELECTRICAL SUPPLY CHECK AMOUNT: $63.54
CARMEL, INDIANA 46032 PO BOX 664117
�.o INDIANAPOLIS IN 46266 CHECK NUMBER: 179283
CHECK DATE: 11111/2009
UEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBE AMOUNT DESCRIPTION
651 5023990 S1047417880 63.54 OTHER EXPENSES
DETACH UPPER PORTION AND RETURN WITH YOUR PAYMENT
CUST OMER NUMBER
74918 JOE 278
ORDERED BY, SALES OFFICE PHONE NUMBER SHIP CIA TE
SALESPERSON SHIP VIA
CARL B HINES PK PICK -UP JOE FISHERS 317 598 -6170 10/28/09
SHIP OTY CIESCRIPTON ITEM PRICE
UNIT.. EXT AMOUNT CASH DISC
lea lea ADVA 71 A6051001 D 63.54 lea 63.54
MH BAL 40OW M59 5 -TAP KIT
Billing Questions: Billing_request @kirbyrisk.com (765) 446 -3054 101281200911:47:69AM 5104741788.001 Invoice Number S104741788,001
Subtotall 63.54
S &H Chargesl 0.00
Invoice is due by 11/30109. J) Sales Tax 0.00
JDE i 0 63.54
000 :0001 Kirby Risk Page 1 of 1
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Prescribed by State: Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL E;
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per clay, number of units,
price per unit, etc.
Payee
351017
KIRBY RISK ELECTRICAL SUPPLY Purchase Order No,
PO BOX 664117 Terms
INDIANAPOLIS, IN 46266 Due Date 11/3/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/3/2009 S1047417881 $63.54
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
Date Officer
VOUCHER 096693 WARRANT ALLOWED
E
851017 IN SUM OF
KIRBY RISK ELECTRICAL SUPPLY
PO BOX 664117
INDIANAPOLIS, IN 46266
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
S1047417880 01- 7202 -06 $63.54
I
U
Voucher Total $63.54
Cost distribution ledger classification if
claim paid under vehicle highway fund