209979 06/20/2012 CITY OF CARMEL, INDIANA VENDOR: 355029 Page 1 of 1
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L ONE CIVIC SQUARE DIRTWORKS LLC CHECK AMOUNT: $320.00
CARMEL, INDIANA 46032 5925 E 122ND STREET
CARMEL IN 46033 CHECK NUMBER: 209979
CHECK DATE: 6/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 8156 320.00 CONT SERVICES OTHER
Dirtv®rks, LLC
5925 East 122nd Street Invoice
Carmel, IN 46033 Date .I`nv
Phone (317) 428 -8210 Fax (317) 846 -0338
5/31/2012 8156
Bill To
City of Carmel Utilities
3450 West 131st Street
Westfield, IN. 46074
Due Date
7/1/2012
Date Description Qty Rate Amount
5/1/2012 Ticket #718721, Shop by #72 1 20.00 20.00
5/11/2012 Ticket #638593, Shop by #70 1 20.00 20.00
Same by #72 1 20.00 20.00
Same by 145 1 20.00 20.00
5/16/2012 Ticket #618551, 1007 S. Rangeline Rd by #72 1 20.00 20.00
5/17/2012 Ticket #718655, 126th Lawrence Dr by 472 1 20.00 20.00
5/18/2012 Ticket #909424, 13026 Andover Ct by #145 1 20.00 20.00
5/21/2012 Ticket #909512, Shop by #72 1 20.00 20.00
5/29/2012 Ticket #873240, Carmel Dr by #72 1 20.00 20.00
Same by #145 1 20.00 20.00
5/30/2012 Ticket #769380, Shop by #145 1 20.00 20.00
Same by #72 2 20.00 40.00
5/31/2012 Ticket #739952, Shop by #145 1 20.00 20.00
Same by #72 2 M OO- 4.0.00_
-If Your Account is 60 Days Past Due -Your Account Will be Closed until
Payment Is Received! Total $320.00
alan+� Due $320.00
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
3555029
DIRTWORKS LLC Purchase Order No.
5925 EAST 122ND STREET Terms
CARMEL, IN 46033 Due Date 6/12/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/2012 8156 $320.00
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
Date Officer
VOUCHER 121163 WARRANT ALLOWED
3555029 IN SUM. OF
DIRTWORKS LLC
5925 EAST 122ND STREET
CARMEL, IN 46033
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
8156 01- 6360 -06 $320.00
Voucher Total $320.00
Cost distribution ledger classification if
claim paid under vehicle highway fund