210360 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 117265 Page 1 of 1
ONE CIVIC SQUARE G.W. BERKHEIMER CO, INC
CARMEL, INDIANA 46032 PO BOX 1247 CHECK AMOUNT: $116.92
PORTAGE IN 46368 -9047 CHECK NUMBER: 210360
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 805988 116.92 OTHER EXPENSES
G CO., INC. W Hbf-E 9V M
AIR C ONDITIONING H REFRIGERATION
BRANCH
SOLD TO CITY OF CARMEL 9004 Technology Dr.
760 3RD AVE SW Fishers In 460382885
SUITE 110
CARMEL IN 460320000
SHIP TO
PLEASE REMIT TO
Customer Pickup P 0 BOX 1247
SHIPMENT# 10- 207653 -01 491 1 PORTAGE IN 46368 --9047
CUST. CODE NO. YOUR ORDER NO. INVOICE NO. INVOICE DATE
21448 10 JOE 278 805988 6 20 f2
DESCRIPTION UNIT PRICE TOTAL
2 95001 OT3100 QWIK 608 SELF STUDY EPA EA 58.46 116.92
TAX EXEMPTION CODE: IN 003120155002 SALES TAX
THANK YOU FOR YOUR ORDER
PAST DUE INVOICES INVOICE
CASH .00 L DISCOUNT SUBJECT TO A 27- SERVICE CHARGE AMOUNT 116.92
ALLOWABLE IF PAID BY 10TH PROX, NET 11TH
ORIGINAL INVOICE
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
117265
G.W. BERKHEIMER CO., INC. Purchase Order No.
P.O. Box 1247 Terms
Portage, IN 46368 Due Date 6/28/2012
Invoice Invoice Description
Date Number (or note invoice(s) or bill(s)) Amount
6/28/2012 805988 $116.92
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 125202 WARRANT ALLOWED
117265 IN SUM OF
G.W. BERKHEIMER CO., INC.
P.O. Box 1247
Portage, IN 46368
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
805988 01- 7202 -06 $116.92
Voucher Total $116.92
Cost distribution ledger classification if
claim paid under vehicle highway fund