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176356 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 358825 Page 1 of 1 ONE CIVIC SQUARE MISTER ICE OF INDIANAPOLIS CHECK AMOUNT: $390.00 ti ,za CARMEL, INDIANA 46032 7954 E 88TH ST u INDIANAPOLIS IN 46256 CHECK NUMBER: 176356 SON CHECK DATE: 8/1912009 DEPARTMENT ACCOUNT �PO NUMBER INVOICE NUMBER A MOUN T DESCRIPTION '1207 4353099 40930 390.00 OTHER RENTAL LEASES r4 Lease Invoice Invoice No: 40930 Date: 08/22/2009 OF INDIANAPOLIS Due Date: 08/22/2009 Terms: Due Upon Receipt 7954 East 88th St. Cust PO: Indianapolis, IN 46256 Reference: Monthly service Tel. 317 849 -4466 Lease 50993 Fax. 317 578 -0750 AcctNo: 50993 Billing Address: Location Address: Brookshire Golf Club Brookshire Golf Club Carmel Redevelopment Commissio 12120 Brookshire Parkway 12120 Brookshire Pkwy CARMEL, IN 46033 CARMEL, IN 46033 ltemNo Description Qty Unit Price Extended OE -LEASE Full Service Lease for Outside 1.00 MONTH $195.00 $195.00 Clubhouse Ice Machine OE -LEASE Full Service Lease for 126th St. Pump 1.00 MONTH $195.00 $195.00 House Outside Ice Machine. Due on the 22nd of every month Blank Acount Numbers indicate invoices prior to June 2008 Open Invoices as of: 4- Aug -2009 Invoice Location Account Company Amount Due Date 39440 50993 Brookshire Golf Club $390.00 07/22/2009 Tear Off Return With Payment for proper credit. Invoice No: 40930 Brookshire Golf Club Account 50993 Carmel Redevelopment Commissio Date Due: 08/22/2009 12120 Brookshire Pkwy Sub Total: 390.00 CARMEL, IN 46033 Sales Tax: 0.00 Invoice Total: 390.00 Total This Invoice: 390.00 Mister Ice Of Indianapolis Total Open Invoices $390.00 7954 East 88th Street Indianapolis, IN 46256 Total Due 780.00 Phone: 317- 849 -4466 Fax: 317 -578 -0750 Amount Enclosed: PIWIR 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 J L /X' Purchase Order No. :22 Terms Date Due Invoice invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total CO I hereby certify that the attached invoice(s), or bilf(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 2, 7� IN SUM OF X90. CID ON ACCOUNT OF OF APPROPRIATION FOR AZ's ),'Zo '7 Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT DEPT. k hereby certify that the attached invoice(s), or p Q G 99 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 20 (j Cn, n t �P/ Cost distribution ledger classification if Title claim paid motor vehicle highway fund