210973 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
0 ONE CIVIC SQUARE NORTH CENTRAL CO-OP
CARMEL, INDIANA 46032 PO BOX 299 CHECK AMOUNT: $2,329.05
WABASH IN 46992
CHECK NUMBER: 210973
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT400590 870 . 67 DIESEL FUEL
1207 4231400 GT400590 687 . 08 GASOLINE
2201 4231300 GT400614 771 . 30 DIESEL FUEL
® Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800,720"0550 Call: 800-234-0573 800-807-3673 Call: 574-224"2667
Branch Co. MI Hart MI Noblesville 877-615-2667
P.O.BOX 299 517-278-4561 231-873-2158 765-675-2538
WABASH, IN 46992 800-440-2667 317- 'x$7018823 DATE 07/02/12 16:`'.17
COL�t' STAR? 0. 2 0 END =76.2
GROSS �:'�F o. GA
RY LLONS
4040 SUPER D ", DIESDISTILLATI
** MULT`_r;.E DELIVERIES AT 11" **
IN DIAG�uJSTICS TICKET ##
SALE 18823 DATE 07/02/12 16;57.17
COUNT: START 0.0 END 276.2
GROSS DELIVERY 276.2 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
# MULTIPLE DELIVERIES AT SITE #
Date Init. *# PRINT DIAGNOSTICS TICKET
DUPLICATE TICKET **
Account # $ SALE 63 DATE 07/0^c/12 17:00:02
COUNT: START 0.0 END 233.7
Account GROSS DELIVERY 233.7 GALLONS
Account #
4011 87 E-10 PLUS GASOLINE I
�
**
Account $ MULTIPLE DELIVERIES AT SITE #*
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice 4: GT 400598
BROOKSHIRE GOLF CLUB Date: 7/2/2012
CITY OF CARMEL Time: 16:42
12120 BROOKSHIRE PKWY
CARMEL, IN 46033-
Tr®s Terms Description Item it Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4011 87 E-10 PLUS * 233.7000 2.94000 687.08
State Road Tax O.i8000 42.07
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL * 276.2000 3.00000 828.60
Legend: Invoice Subtotal: 1,557.75
E=Metered, T=Taxable; *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 1,557.75
WARNING - PETROLEUi PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9308 WE
APPRECIATE YOUR BUSINESS'!'.
Customer Signature:
O
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P.O. Box 299
Wabash, IN 46992
$1,557.75
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
1207 GT 400590 42-313.00 j $870.67 1 hereby certify that the attached invoice(s), or
1207 GT 400590 42-31 $687.08 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
Thursday, July 12, 2012
G
Director, Brookshire dolf Club
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))
07/02/12 GT 400590 Diesel $870.67
07/02/12 GT 400590 Gasoline $687.08
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
20
Clerk-Treasurer
® Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
Branch Co. MI Hart MI Nobi i e 877-615-2667
517-278-4561 231-873-2158 765-67 - g DATE 07/86/12 13:48:56
P.O. Box 299 800-440-2667 317-77 - START 0.0 END 251.1
WABASH, IN 46992 IVERY 257.1 GALLONS
4040 MR DX-4 BIODIESDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: 6T GARY TEETERS
Customer: 0000921720 Invoice #: 6T 400614
CAMEL STREET DEPT Date: 7/6/2012
3400 W 131ST STREET Time: 13:36
CAMMEL, IN 46074
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARM TERNS 4040 SUPER DX-4 BIODIESEL E 257.1000 3.OM 771.30
Legend: Invoice Subtotal: 771.36
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.06
Invoice Total: 771.30
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. 6ASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature: C),)./)I/k OCUSTMER
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P. O.. Box 299
Wabash, IN 46992
$771.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
2201 I GT 400614 I 42-313.001 $771.30 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
>X
E Wednesd� ;/�uly 11, 2012
Street Commissioner
5,"MnF pf ^nmmi�si�nar
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))
07/06/12 GT 400614 $771.30
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