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206706 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 359984 Page 1 of 1 t ONE CIVIC SQUARE INDIANA GOLF CAR CHECK AMOUNT: $66.90 CARMEL, INDIANA 46032 1770 B EAST 266TH STREET ARCADIAIN 46030 CHECK NUMBER: 206706 CHECK DATE: 2/28/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1207 4350000 3526 66.90 EQUIPMENT REPAIRS M Indiana Golf Car, Inc. Invoice 1770 B E 266th Date Invoice Arcadia, IN 46030 2/21 /2012 3526 Bill To Ship To BROOKSHIRE G.C. BROOKSHIRE G.C. 12120 BROOKSHIRE PKWY. 1.2120 BROOKSHIRE PKWY. CARMEL, IN 46033 CARMEL, IN 46033 P.O. Number Terms Rep Ship Via E.O.B. Project RUSSELL Net 30 2/21/2012 Quantity Item Code Description Price Each Amount 1 103517401 KIT PD3 BUTTON DIODE 4190 41.90 1 REPAIR LABOR REPAIR LABOR 25.00 2.5.00 REPAIRED CHARGER Total $66.90 VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Golf Car, Inc. IN SUM OF 1770 B E 266th Arcadia, IN 46030 $66.90 ON ACCOUNT OF APPROPRIATION FOR Brookshire Golf Club PO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members 1207 1 3526 43- 500.00 I $66.90 1 hereby certify that the attached invoice(s), or I 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 Friday, February 24, 2012 Director, BroAshire Golf Club Title 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)) 02/21/12 3526 Repair Parts $66.90 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