210053 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00351569 Page 1 of 1
ONE CIVIC SQUARE KELLER RIVEST
0 CHECK AMOUNT: $162.00
CARMEL, INDIANA 46032 6935 BROOKVILLE ROAD
+y s� aco INDIANAPOLIS IN 46239 -1003 CHECK NUMBER: 210053
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 24649 162.00 REPAIR PARTS
Invoice
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OQ35 Brookville Rd
Indianapolis, |N4O230 0
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Telephone: 317/359-9000
Bill To: Ship To:
Carmel Utilities Conno|VY.VVT.P.
780 Third Ave. SVV 0000 Hazel Dell Parkway
Suite 110 Indianapolis, )N4028O
Carmel, |N40032
ustomer
erm
ARWK8 Net 30 Days
Jeff Co per 456 209 05/25/12 4209
TIE
F, Quantity Shipp rn UnV re
VW
1 1 SHIP 12.00 12.00
0 Shipping Charges N
Net due on 06/28112
Nontaxable Subtotal 162.00
Taxable Subtotal 0.00
Tax 0.00
Total Invoice
Customer Original Page 1
VOUCHER NO. WARRAN NO.
ALLOWED 20
Keller Rivest
IN SUM OF
6935 Brookville Road
Indianapolis, IN 46239
$162.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 I 24649 I 42- 370.001 $162.00 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
a Friday, d /17 e 15, 2012
II G
f
Street Commissionery
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))
05/29/12 24649 $162.00
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