208592 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 358798 Page 1 of 1
ONE CIVIC SQUARE AMERICAN CLEAN SEAL
CARMEL, INDIANA 46032 4469 BRAGDON STREET CHECK AMOUNT: $175.00
INDIANAPOLIS IN 46226
CHECK NUMBER: 208592
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1094 4350100 4335 175.00 BUILDING REPAIRS MA
1 E°CEIVED
AMERICAN CLEAN SEAL
4469 BRAGDON STREET
INDIANAPOLIS, INDIANA 46226 APR 3 0 2012 INV
FED. ID. #43-2014054
(317) 536 -0211
y:
Date: 04/27/12 Inv. No.: 4335
Due Date: 05/07/12 Page No.: I
Ship To /Remarks
Carmel Clay Parks Rec Monon Comm.
Dawn Koepper
1235 Central Park Drive East
Carmel IN 46032
REFERENCE TERMS YOUR OUR SALES REP
Net 10 Days
e e e
o
MASONRY REPAIR Repair of Masonry Surfaces Per Job 1.0 175.0000 175.00
Patched and painted an area in the
pool tub by the railing.
Job Location: Lary River
Job Completed: 4 -23 -12
Thank You Very Much for your Business
Q
MAY 0 1X012 I
Purchase
Descriptiorr *t By'
P.O. G P o
G. L. 1094 43501 ®D
Budget
Line Descr
Purchaser Date
Approval Date
SUB TOTAL 175.00
TAX 0.00
TOTAL 175.00
NET TO PAY 175.00
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
Purchase Order No.
358798 American Clean Seal Terms
4469 Bragdon Street
Indianapolis, IN 46226
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
E 4/27/12 4335 Patch job on lazy river 175.00
Total 175.00
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
20_
Clerk- Treasurer
Voucher No. Warrant No.
358798 American Clean Seal Allowed 20
4469 Bragdon Street
Indianapolis, IN 46226
In Sum of
175.00
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1094 4335 4350100 175.00 1 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
3 -May 2012
Signature
175.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
i