169651 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00351747 Page 1 of 1
I. 0 ONE CIVIC SQUARE TRI STATE BEARING CO INC CHECK AMOUNT: $2,033.68
CARMEL, INDIANA 46032 PO BOX 4737
'g o. EVANSVILLE IN 47724 -0737 CHECK NUMBER: 169651
CHECK DATE: 314!2009
DEPARTMENT W ACCOUNT PO NUMBER INV OICE NUMBE AMOUNT DE SCRIPTION
651 5023990 S11501 285189 1,964.13 BEARINGS, SEALS.
651 5023990 286401• 69.55 MATERIALS SUPPLIES
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i
TRI -STATE BEARING INVOICE
Shipped from:
2205 ENTERPRISE PARK PLACE
INDIANAPOLIS, IN 46218 Customer Copy
PH317 -924 -3287 FX317- 924 -3561
Remit to: Number 285189
P.O.Box 4737
Evansville, IN 47724 -0737 Date 02/16/09
GW 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 1 9609 Hazel Dell Pkwy
Suite 110 Indianapolis, IN 46280
Carmel, IN 46032
Reference Shipped Salesperson Terms Tax.Code Doc Wh Freight Ship Via
511501 02/12/09 Zl House Indi NET 30 DAYS X 964358 07 PRE /ADD UPS
Item Description Ordered Shipped Backordrd UM Price UM Extension
MRC 5222C *DOUBLE ROW BALL BRG 1.00 1.00 .00 EA 865.13 EA 865.13
ROL UI224B *CYL.ROLLER BRG:NON 1.00 1.00 .00 EA 1036.93 EA 1036.93
CHI 44967 OIL SEAL 1.00 1.00 .00 EA 25.00 EA 25.00
CHI 37396 OIL SEAL 1.00 1.00 .00 EA 16.90 EA 16.90
ZZZ FREIGHT INCOMING FREIGHT CHA 1.00 1.00 .00 EA 8.33 EA 8.33
1Z466E460348408431
Merchandise Misc Discount Tax Freight Total Due
1952.29 .00 .00 11.84 1964.13
WE APPRECIA'T'E YOUR BUSINESS
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) E
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 i?
EVANSVILLE, IN 47724 -0737 Due Date 2/2312009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/23/2009 285189 $1,964.13
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hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance w IC 5- 11- 10 -1.6
/z L/1
Date Officer
VOUCHER 095089 WARRANT ALLOWED
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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
285189 01- 7200 -03 $1,943.96
285189 01- 7200 -03 $20.17
so
Voucher Total $1,964.13
Cost distribution ledger classification if
claim paid under vehicle highway fund
a
TRI -STATE BEARING INVOICE
Shipped from:
2205 ENTERPRISE PARK PLACE
INDIANAPOLIS, IN 46218 Customer Copy
PH317 -924 -3287 FX317- 924 -3561
Remit to: Number 286401
P.O.Box 4737
Evansville, IN 47724 -0737 Date 02/23/09
DLS Phone: 812 425 -1336 Fax: 812 -421 -6788 P age 1
BiN To: Carmel Utilities Ship To: Carmel Wastewater Treatment PI
7930 760 3rd Ave SW 1 9609 Hazel Dell Pkwy
Suite 110 Indianapolis, IN 46280
Carmel, IN 46032
Reference Shipped Salesperson Terms Tax Code Doc Wh 'Freight Ship Via
VERBAL -JEFF 02/17/09 ZI House Indi NET 30 DAYS X 965757 07 PRE /ADD FED X PRI 1 DIR
Item. Description Ordered Shipped Backordrd UM Price UM Extension
NRD 22012005 *AUTO VENT PLUG;M12 1.00 1.00 .00 EA 12.30 EA 12.30
NRD 22024005 *AUTO VENT PLUG;M24 1.00 1.00 .00 EA 26.15 EA 26.15
Merchandise Misc Discount Tax Freight Total Due
38.45 .00 .00 31.10 69.55
WE APPRECIATE YOUR BUSINESS
Form No. ribe301-5 St e Rev.1995) Board ofAccounts ACCOUNTS PAYABLE VOUCHER
Form 301 (v. 19
TO
ADDRESS
Invoice Date Invoice Number Item Amount
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
1 19
Signature Title
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.
Officer Title
Voucher No. Warrant No.
l
ACCOUNTS -PAYABLE DETAILED ACCOUNTS
SANITATION DEPARTMENT ACCT
CARMEL, INDIANA NO-
Favor Of
lR� S fA> P �d�9R -'N9
Total Amount of Voucher
7� Deductions
69 s
Amount of Warrant
Month of 19
Acct.
VOUCHER RECORD No.
Collection System
Operation
Plant
Commercial
General
Undistributed
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325