208377 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 357776 Page 1 of 1
`•i. ONE CIVIC SQUARE MASTHEAD INDUSTRIES
CARMEL, INDIANA 46032 PO BOX 861777 CHECK AMOUNT: $452.92
ORLANDO FL 32886 -1777
CHECK NUMBER: 208377
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1203280300 452.92 TRANSPORTATION EXPENS
0 P ®�E� 5520 B Kopetsky Drive
INVOICE
USA Indianapolis, IN, 46217
Ph: (317) 786 -7919 Fax: 317- 786 -7910 12032803 -00
TRACKING
OUST 3357 ORDER DATE 03/27/12 TAKEN BY 1'2RR P.O TRUCK 15' DATE >03/27/12.
INSTRUCTIONS SHIP VIA HOSEiBOSS PAGE 1
Bill To: CITY OF CARMEL Ship To: CARMEL SEWAGE DEPT.
ONE CIVIC SQUARE 901 N RANGELINE RD
CARMEL, IN 46032 CARMEL, IN 46032
LINE ITEM NUMBER DESCRIPTION I COMMENTS U/M ORDERED B O /RET SHIPPED:.. UNIT PRICE AMOUNT
1 HOSE ASSEMBLY PP_300 -12 E12 -12FF E12 -FF EA 1 0 1 301.42 301.42
90 138"
2 14- 120 7W -100 CABLE TIE 14 120LB BLK EA 3 0 3 0.50 1.50
3 SERVICE CALL M -F 0800 -1700 LT 1 0 1 75.00 75.00
4 LABOR SHOP SERVICE HR 1 0 1 75.00 75.00
M -F 0800 -1700
:::SUB TOTAL 452:92 MIN DEL FEE 'i FREIGHT IN sFREIGHT OUT SALES TAX
TERMS: Customer agrees to pay a service charge of 1 -1 /2 per month, TERMS. N ET 30
a true rate of 18% per annum on any amount past due and to pay reasonable TOTAL: DUE 4 92
attorney's fees if it becomes neccessary to file suit to enforce collection.
Accounts past due may be placed on a COD basis without notice. A $35 fee
will be charged for returned checks. Special orders may not be returned or
payment refunded. No items will be accepted for return without authorization.
All returns are subject to a restocking charge plus any freight charges incurre
Orders below minimum level are subject to a delivery charge.
Retain This
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
357776
MASTHEAD HOSE SUPPLY Purchase Order No.
LOCKBOX #861777 Terms
11050 LAKE UNDERHILL ROAD Due Date 4/16/2012
ORLANDO, FL 32825
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/16/2012 1203280300 $452.92
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 Kfficer
VOUCHER 117159 WARRANT ALLOWED
357776 IN SUM OF
MASTHEAD HOSE SUPPLY
LOCKBOX #861777
11050 LAKE UNDERHILL ROAD
ORLANDO, FL 32825
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1203280300 01- 7502 -06 $452.92
Voucher Total $452.92
Cost distribution ledger classification if
claim paid under vehicle highway fund