HomeMy WebLinkAbout180512 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 354229 Page 1 of 1
ONE CIVIC SQUARE R M DIPATTI
CARMEL, INDIANA 46032 PO BOX 1167 CHECK AMOUNT: $975.00
RICHMOND IN 47375 CHECK NUMBER: 180512
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUNT PO NUMBE INV NUMBER AMOUNT DESCRIPTION
1701 4347500 467213 975.00 BOND CORDRAY
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�Client: Diana Cordray (B)
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7 77 7 71
Policy #5067093 0110112010-011011
2011
Ohio Casualty Group
467113 01/01/M10 Renew policy, Public Official Bond Diana. Cordray" 975.00
$300,000
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PLEASE PAY WITHIN 20 DAYS OF INVOICE DATE.OR CALL IMMEDIATELY IF INVOICE IS 7 Thank 5.00
INCORRECT.
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317.845.1547 /10/200 9
PrescritF�3y 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.
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
To 1 I
c m 6yid T g136
cin6,
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I 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
0 if 4 20
Signatid
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund