207631 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 00351747 Page 1 of 1
ONE CIVIC SQUARE TRI STATE BEARING CO INC CHECK AMOUNT: $75.58
CARMEL, INDIANA 46032 PO BOX 4737
EVANSVILLEIN 47724 -0737 CHECK NUMBER: 207631
ICON O
CHECK DATE: 3/26/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 477533 75.58 OTHER EXPENSES
TRI -STATE BEARING INVOICE
Shipped from:
2205 ENTERPRISE PARK PLACE
INDIANAPOLIS, IN 46218
PH317- 924 -3287 FX317- 924 -3561
Remit to: Number 4 77533
P.O. Box 4737 Dare. 03 /06/2012
CW Evansville, IN 47724 -0737
Phone: 812- 425 -1336 Fax: 812- 421 -6788 Page 1
Bill To:, Carmel Utilities Ship" To: Carmel Wastewater Treatment Pl
7930 760 3rd Ave SW Ste 110 1 9609 Hazel Dell Pkwy
Carmel, IN 46032 Indianapolis, IN 46280
Reference Shipped Salesperson Terms Tax'Code Do,
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JEFF COOPER 03/02/12 ZI House Indi NET 30 DA
YS X 112990 07 PRE(ADD UPS DIRECT
ltem Description Ordered Shipped Back ordrd UM Price UM Extension
NAC6203 BALL BEARING 1.00 .00 1.00 EA 5.81 EA .00
PTIRVFW207 -35MM *PILOTED 4 -BOLT FLAN 2.00 2.00 .00 EA 32.84 EA 65.68
*35MM BORE
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65.68 .00 .00 9.90 75.58
WE APPRECIATE YOUR BUSINESS
Customer Copy Last Page
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
351747
TRI -STATE BEARING CO., INC. Purchase Order No.
P.O. BOX 4737 Terms
EVANSVILLE, IN 47724 -0737 Due Date 3/19/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/19/2012 477533 $75.58
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
Date Officer
VOUCHER 116997 WARRANT ALLOWED
351747 IN SUM OF
TRI -STATE BEARING CO., INC.
P.O. BOX 4737
EVANSVILLE, IN 47724 -0737
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
477533 01- 7202 -06 $75.58
Voucher Total $75.58
Cost distribution ledger classification if
claim paid under vehicle highway fund