175106 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 363116 Page 1 of 1
ONE CIVIC SQUARE ROCK TRANSPORT CHECK AMOUNT: $54.15
`o CARMEL, INDIANA 46032 10101 N GRAY ROAD
INDIANAPOLIS IN 46280 CHECK NUMBER: 175106
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRIPTION
1207 4236000 2120 54.15 GRAVEL
Rock Transport Invoice Date: 09- Jul -09
Remit To: 10 10 1 North Gray Road INVOICE 2120
Indianapolis, IN 46280 JOB BROOKSHIRE GOLF
Sold To:
JOB NAME: CARMELFEST
BROOKSHIRE
BROOKSHIRE GOLF CLUB /CITY OF CA JOB TYPE: TONNAGE
PO
12120 BROOKSHIRE PKWY
CARMEL, IN 46033 WEEK ENDING: 7/4/2009
TONNAGE INVOICE
DATE EMP /TRK# TICKET TONS RATE FSC TONS FSC RATE TO
7/1/2009 021:NA 6083622 19.69 $2.75 0.00 $0.00 $54.15
TOTAL FOR 7/1/2009 19.69 0.00 $54.15
TOTAL TONS: 19.69 0.00
OF TICKETS
PLEASE PAY THIS AMOUNT: TOTAL CUSTOMER INVOICE: $54.15
NET DUE UPON RECEIPT: 1 1/2% ON PAST DUE INVOICES AFTER 30 DAYS
Any questions in regard to this invoice, please call (317) 846 -5100
Thank You We Appreciate Your Business!
Marti rietta Aggregates CENTRAL DISPATCH NOTES REVISIONS:
DAY DATE: TIME WANTED:
MOTES:
O.QCK TRAMS- P'On 9 4919240
C-4 TRUCKS:
M96Th St Noblesville Belmont N Topsoil Pr'
Carmel S &G F Kentucky Ave Waverly E] S Topsoil
Metric Tax Exempt CR Card E] Quoted Job
Customer r' IS i ce t V 4 p
Acct#: Job 0
P.O. HAUL: 16, ZONE:
gv�c�`�i 2
JOB NAME:
LOCATION: opS v-�_ ,cam, da lr
C c
MATERIAL PROD CODE
a
0
ORDERED BY: Q d 2%
ON SITE CONTACT:
PHONE
REC'D BY:
www.martinmarietta.com Ticket# 6083622
Sold To: 2520,45Job# 2,520950389 001 Sold From: 25102North Indianapolis
INDIANA DISTRICT P/R ACCOUNT 4700 East 96th Street
PO BOX 549 (317) 846 -6131
CARMEL IN 46032 3
Date: 07 /01/09 Time: 12:55 PO No: Job /Dest. Information
486240 Truck:RT426 PAUL FUQHE�
Hauler: DELCAR LLC DBA HaUiRate 7S- GOLF COURSE
DBA ROCK TRANSPORT CARMELFEST DONATION
17306 WESTFIELD PA
12120 BROOKSHIRE PKWY
Lot#
Lds Today To Date Lbs Tons Cash Sale m g
Quantity Quantity Gross: (1) 67,560 33.78 Matl v
Job: 1 19.69 19.69 Tare: 28,180 14.09 Tax IN a m D
De st:l 19.69 19.69 Net: 39,380 19.69 Haul p z
Product Number: 0639 Payment Recvd By: m 0
Desc: IN #73 TYPE 0 ST Total$ m p, o. U, N
Sbc. Product: 0.00 QTY: 19.69 Ton Max GVW: 68,000.00 Z
Additional Information: Weighperson KATHY m
LEDGES 8 -14 9620 INDOT SOURCE 2311 Q962010
M -F 7:00 -4:00 SAT CLOSED
m
Driver: Customer:
Martin Marietta Materials Standard Terms and Conditions apply (copy available at Site office).
Pursuant to prior oral or written agreement between the parties, delivery occurred and title passed immediately after the products were loaded into the carrie�r the point of
shipment.
All hauling from this plant or quarry at an agreed rate per ton or yard is performed by independent trucking contractors. Drivers, other than owner drivers, will be employed by
the trucking contractor. The trucking contractor assumes all liability for compensation, public liability, and property damage insurance, also all social security taxes, withholding
taxes, and any other taxes assessed.
WARNING: AVOID BREATHING DUST FROM ••D
This product contains crystalline silica. Prolonged and repeated breathing of crystalline silica dust can cause a progressive lung disease called silicosis.
Also, some researchers have reported that there is evidence that prolonged and repeated breathing of crystalline silica dust might cause lung cancer.
Either silicosis or lung cancer can result in permanent injury or death.
To reduce the risk of injury, limit exposure time and use a dust mask or respirator.
For detailed information, including the manufacturer's position, see the Material Safety Data Sheet before using or handling this product. MSDS are available on our website at
www.martinmarietta.com or ask the plant manager for a copy.
POLVO DE ESTE PRODUCTO 9
t
Este producto contiene silice cristalina. Respirar el polvo de la silice cristalina repetidamente y por periodos prolongados puede causer la silicosis, una enfermedad
progresiva de los pulmones.
Asimismo, algunos investigadores reportan la existencia de evidencia que muestra que el respirar el polvo de la silice cristalina de forma repetida y por periodos prolongados
podria causar cancer del pulm6n.
Tanto la silicosis como el cancer de pulm6n pueden causar danos permanentes o la muerte.
Para reducir el riesgo de sufrir danos a la salud, debe limitar el tiempo que este expuesto at polvo de la silice cristalina y usar una mascarilla que to proteja del polvo o un
respirador.
Para mayor informaci6n, incluyendo el punto de vista del fabricante, favor de ver la Hoja de Datos sobre la Seguridad de los Materiales (Ilamada "Material Safety Data Sheet")
antes de usar o manejar este producto. La Hoja de Datos sobre la Seguridad de los Materiales esta disponible en nuestro sitio web www.martinmarietta.com o le puede pedir
una copia a su gerente de planta.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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.
10101 n 6, r, Terms
1 c\ b", V,5 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
G -0 9 o��
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
-�S V, l5
ON ACCOUNT OF APPROPRIATION FOR
/107 60nera,l fir d,
43f^cv I-e, (v o1F elP
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3 /o -co S y s 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
)O 20 Q
At 4 ture
Cost distribution ledger classification if T itle
claim paid motor vehicle highway fund