208796 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 357776 Page 1 of 1
ONE CIVIC SQUARE MASTHEAD INDUSTRIES
CARMEL, INDIANA 46032 PO BOX 861777 CHECK AMOUNT: $225.86
o o ORLANDO FL 32886 -1777 CHECK NUMBER: 208796
CHECK DATE: 5110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1203363600 225.86 OTHER EXPENSES
P Indianapolis, 0s INVOICE
46217
USA Ph: (317) 786 -7919 Fax: 317- 786 -7910 12033636 -00
TRACKING
COST 3357 ORDER DATE 04/1j9/12 TAKEN' 'Cl 2RR P.O.# AIR LINES
DATE 04/19/12
INSTRUCTIONS
SHIP VIA HOSE BOSS 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! COMMENTS OM:.. ORDERED B O./RET SHIPPED UNIT PRICE AMOUNT
2 0 2 69.41 138.82
1 T08
CE CALL M -F 0800 -1700 LT 1 0 1 75.00 HOSE ASSEMBLY PX300 -08 E08FJ FP 27" 2 6.02 12.04
2 M -JIC M -NPT 90DEG 2
3 75.00
SUB TOTAL: 225.86) MIN DEL FEE
-Xx
".."xXx
FREIGHT IN FREIGHT OUT SALES TAX
TERMS: Customer agrees to pay a service charge oft -vz %per month, TERMS: NET 30 TOTALDUE 225 86'
a true rate of 18% per annum on any amount past due and to pay reasonable
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 Portion For YDur Records
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 4/30/2012
ORLANDO, FL 32825
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/30/2012 1203363600 $225.86
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 Officer
VOUCHER 117219 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
1203363600 01- 7202 -06 $225.86
Voucher Total $225.86
Cost distribution ledger classification if
claim paid under vehicle highway fund