171942 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 202000 Page 1 of 1
ONE CIVIC SQUARE MIDWEST BRAKE WHEEL, INC
6 CHECK AMOUNT: $407.24
CARMEL, INDIANA 46032 PO BOX 2933
off INDIANAPOLIS IN 46206 -2933 CHECK NUMBER: 171942
CHECK DATE: 4/29/2009
DL"PARTMENT ACC PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTI
X651 5023990 44141 407.24 OTHER EXPENSES
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II V 11OWES 1 O AKE O WHEEL, EEL, V C. INVOICE DATE
INVOICE 40. 2 2 0 0 9 PAGE
1140 S, West Street PO.Box 2933 3120 Congressional Pkwy.
INDIANAPOLIS, IN 46206 -2933 FT. WAYNE, IN 46808 1291120017 1
CUSTOMER NO. BRANCH
Phone: (317) 632 -4487 Phone: (260) 482 -5243
www.mwbrake.com (800) 944 -9433 1 10099 1*
SOLD v_ C I TY OF CARMEL_ SHIP CITY OF CARMEL
TO STREET T DEPT TO STREET DEPT
3401:: W 131 ST STIR EET 3400 W 131ST S 1 "BEET
CARMEL, IN 45074 WESTI~ IELD IN 46074
PLEASE REMIT TO: P.O. SOX 2933 INDIANAPOLIS, IN 46206 -2933
CUSTOMER P.O. R/S ORDER NO,
JEFFCOOPER 845817 (317) 733 -2001 1` 001
QUANTITY I PART NO. PRICE/PER I EXTENSION
2 EU E -8858 EUCLID WHEEL CYLINDER 150.89 .r I LOEA 155.20
2 EU E -8859 t`_` W HL CYLINDER '14 6-54 77.501 A* 155.20
4 LS F85053EX LINED BRAKL SHOE W 52.82 EXC 24. 21 EA 95.84
4 LS CL.ASS42 s 1 F85053 SHOE CORE CHG 1 5 00EA 60.00
4- LS CLASS42 -C1 F85053 SHOE CORE RET 15.00EA 60.00CR
WILL CALL WILL CAL I-
CIJSl OlvlER WAS GIVE LN FOR
2 SHOES W ILL BRIN(-' IN
HI CORES FOR R`EI" I N
WI 1. N AND SHOP TAG IS
P[ZEW c I TTEN AND P
S1 ".Ii: ES ALREADY BUILT IN SYS.
ORDER PICKED BY: BS
AT .MIDWEST BRAKE WE APPRECIATE YOUR BUS INE:u c I
YOU ^2E T1-1E ztL:ASO(.1 WE Ai�B r1i:RE TI-{I',NK r'OLfV�
CORES MUST BE RETURNED WITHIN 90 DAYS.
FREIGHT TAXABLE SUB TOTAL TAX STATUS /STATE. SALES TAX PLEASE PAY.
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407.24 E Iil 0..00 407.24
PAYMENT TERMS: Open accounts due and payable on or before the 10th day of the month following the
date of purchase. Any account beyond thesg terms will be subj�c o credit �old..A 1 -1/2% service charge per
CUSTOMER SIGNATURE month will be charged on past due (b Ado it E 4 4 t.x i"C �..J:\
09:30 AID
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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
202000
MIDWEST BRAKE WHEEL INC Purchase Order No.
PO BOX 2933 Terms
INDIANAPOLS, IN 46206 Due Date 4/23/2009
Invoice Invoice Description
Date Number (or note attached invoice(s)'or bill(s)) Amount
4/23/2009 1291120017 $407.24
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
VOUCHER 095553 WARRANT ALLOWED
202000 IN SUM OF
MIDWEST BRAKE WHEEL INC
PO BOX 2933
INDIANAPOLS, IN 46206
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
U Board members
PO INV ACCT AMOUNT Audit Trail Code
1291120017 01- 7502 -06 $407.24
ol1
Voucher Total $407.24
Cost distribution ledger classification if
claim paid under vehicle highway fund