208847 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 356009 Page 1 of 1
ONE CIVIC SQUARE R G A /HOOSIER RUBBER TRANS MISS p
CARMEL, INDIANA 46032 3905 EAST PROGRESS STREET HECK AMOUNT: $69.61
r NORTH LITTLE ROCK AR 72114
CHECK NUMBER: 208847
CHECK DATE: 5110/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 E93841 -001 69.61 MATERIALS SUPPLIES
INVOICE
MAIL REMITTANCE TO: ENTERING OFFICE INVOICE NUMBER TRAN
CODE
M HOOSIER RUBBER TRAN. E93841 -001 DI
R(;q 2002 LAFAYETTE RD. INVOICE DATE PAGE
INDIANAPOLIS IN 46222 04/17/12 1
AN EMPLOYEE OWNED COMPANY
3905 East Progress Street
Any different or additional terms that may be embodied in your purchase order are hereby objected to. It your order is not an
North Little Rock AR 72114 acceptance of our proposal, this will operate as an acceptance of your order only in the event you agree to the terms hereof.
The terms and conditions contained above and attached shall apply.
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LINE PAHi;NtfIN13ER::::l CE
llNfT OF fNEA$LfRE UNIT E!RI EX7EN13ED.
NO TOTAL 13AGK: TH:E5 1ASCft1PT1.ON 5> PfiQf7UCT DISGOU..(dT �o A]YIOUWT
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10 25 25 8131 -3756 2.1500 53.75
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FOLD
CUST. NO. ORDER DATE TERR PC ORD Written By DATE SHIPPED WHSE AMOUNT 53.75
TC125 04/16/12 TD 70 S GLF 04/17/12 70 f
FRGHT /INS /HNDL 15.86 I 1
Carrier: UPS FOB: SP,FNA,PREPAID ORIGINAL INVOICE SALES TAX 00
Terms of Payment: NET 30 DAYS INVOICE TOTAL 69.61
Please Pay This Amount j
ORDER ISSUED IN: INDIANAPOLIS
Note New Remit To Address PHONE: 317/634 -3976
3905 East Progress Street
North Little Rock, AR 72114
Customer PO No. S13063 Mark No.
s CARMEL UTILITIES s CARMEL WASTE WATER
0 760 3RD AVENUE SW H 9609 HAZEL DELL PARKWAY
D SUITE 110 I
T CARMEL IN 46032 T INDIANAPOLIS IN 46280
0 0
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
350590
RGAMOOSIER RUBBER TRANSMISSON Purchase Order No.
3905 E. Progress Street Terms
North Little Rock, AR 72114 Due Date 4/30/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/30/2012 E93841 -001 $69.61
I 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
s// IJ 2, ftt" a Q
Date Officer
VOUCHER 117238 WARRANT ALLOWED
350590 IN SUM OF
RGA/HOOSIER RUBBER TRANSMIS
3905 E. Progress Street
North Little Rock, AR 72114
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
E93841 -001 01- 7202 -06 $69.61
Voucher Total $69.61
Cost distribution ledger classification if
claim paid under vehicle highway fund