209160 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
ONE CIVIC SQUARE GENERAL SHALE BRICK
CARMEL, INDIANA 46032 PO Box 5826 CHECK AMOUNT: $1,039.38
gi p CAROL STREAM IL 60197 -5825 CHECK NUMBER: 209160
<Ipy GO
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
206 R4237001 27481 181618819 1,039.38 STORM SEWER MAINT SUP
General Shale
Brick MMMMME
Building The American Dream
Invoice: 181618819• Invoice Date: 04/27/2012
Bill To: 279670 Customer PO: Shop
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 171806880
WESTFIELD IN 46074 -8267 Goods Issue Date: 04/27/2012
Order: 314619859
Sales Rep: 399
Ship -To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074 -8267 Phone: 317 846 -2566
Mode of Shipment: Customer Pickup 057
Material Material Description Quantity Price Value USD
Batch Number and Description
6099001047 ESSROC BRIXMENT GRAY TYPE S 100 BAG 8.10 810.00
6099010275 4 X 8 X 16 SOLID BLOCK 204 EA 1.03 210.12
6099000209 MASONftS BRUSH 2 EA 9.63 19.26
Subtotal 1,039.38
TAX
TOTAL 1,039.38
LATE PAYMENT CHARGE of 1.5% PER MONTH.
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT
Accnt Customer Name Invoice -Date Invoice Amount Due
279670 CITY OF CARMEL 04/27/2012 181618819 1,039.38
Remit To: GENERAL SHALE BRICK, INC
PO Box 5825
CAROL STREAM IL 60197 -5825
Terms: Take discount of $20.79 If paid on or before 05/27/2012 NET 45 DAYS.
VOUCHER NO. WARRANT NO.
ALLOWED 20
General Shale and Brick
IN SUM OF
P. O. Box 5825
Carol Stream, IL 60197 -5825
$1,039.38
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
27481 I 181618819 I 42- 370.01 I $1,039.38 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
iThursday, May 17, 2012
)0/ A
Street Commissioner
btreeT ivv.
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/27/12 181618819 $1,039.38
1 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