207493 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 359984 Page 1 of 1
0 ONE CIVIC SQUARE INDIANA GOLF CAR CHECK AMOUNT: $269.00
CARMEL, INDIANA 46032 1770 B EAST 266TH STREET
L off ARCADIA IN 46030 CHECK NUMBER: 207493
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 3594 269.00 EQUIPMENT REPAIRS M
Indiana Golf Car, Inc. In voice
1770 B E 266th
Date Invoice
Arcadia, IN 46030
3/19/2012 3594
Bill To Ship To
BROOKSHIRE G.C. BROOKSHIRE G.C.
12120 BROOKSHIRE PKWY. 12120 BROOKSHIRE PKWY.
CARMEL, IN 46033 CARMEL, IN 46033
P.O. Number Terms Rep Ship Via F.O.B. Project
RUSSELL Net 30 3/19/2012
Quantity Item Code Description Price Each Amount
1 CCX8506 CIRCUIT BREAKER, 15A/1 20V 13.10 13.10
1 103429301 PD3 CASE ASSEMBLY 91.80 91.80
3 :103628701 SPRING ASM, FRONT, 1 LEAF 44.70 134.10
1 ,REPAIR LABOR REPAIR LABOR 30.00 30.00
FIXED CHARGER
ate 3 init.
ccount
ccount
ccount
ccount
To $269.00
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))
03/19/12 3594 Repair Parts $269.00
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
Indiana Golf Car, Inc.
IN SUM OF
1770 B E 266th
Arcadia, IN 46030
$269.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1207 I 3594 I 43- 500.00 I $269.00 1 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
Thursday, March 22, 2012
l
Director, Brookshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund