180161 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 174625 Page 1 of 1
ONE CIVIC SQUARE KIRBY RISK SUPPLY CO CHECK AMOUNT: $730.50
CARMEL, INDIANA 46032 PO BOX 664117
INDIANAPOLIS IN 46266 -4117 CHECK NUMBER: 180161
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 5104782002 730.50 OTHER EXPENSES
DETACH UPPER PORTION AND RETURN WITH YOUR PAYMENT
If .i NUMBER
74918 drive
SAL ES OFFICE PHONE NUMBER SHIP DATE
SALESPERSON SHIP VIA'.. ORDERED BY
MARK S BAYS WC51 WILL -CALL jeff cooper FISHERS 317 598 -6170 11/19/09
SHIP OTY IC UNIT
lea lea AB 22A- D8P7N104 730.50 lea 730.50
POWERFLEX 4 AC DRIVE, 480VAC, 3PH,
8.7 AMPS, TYPE IP20
Billing Questions: Billing_ request @kirbyrisk.com (765) 446 -3054 VM20082:16:50Ph S104782002.001 Invoice Number 5104782002.001
Subtotal 730.50
S8�H Charges 0.00
Invoice is due by 12131109. 9� Sales T 0.00
eff c per
ax 730.50
0001:0001 i Page I of 1
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Prescribed by State Board of Accounts City Form No. 201 (Pev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
174625
KIRBY RISK SUPPLY CO Purchase Order No.
PO BOX 664117 Terms
INDIANAPOLIS, IN 46266 Due Date 12/1/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/1/2009 S104782002, $730.50
�i
I hereby certify that the attached invoice(s), or bills) is (are) true and
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 096835 WARRANT ALLOWED
`,74625 IN SUM OF
i
KIRBY RISK SUPPLY CO
PO BOX 664117
INDIANAPOLIS, IN 46266
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
S104782002.1 01- 7202 -06 $730.50
Voucher Total $730.50
Cost distribution ledger classification if
claim paid under vehicle highway fund