211611 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 366463 Page 1 of 1
ONE CIVIC SQUARE 96TH STREET TRANSFER AND RECYCLW�
q 0 CARMEL, INDIANA 46032 CHECK AMOUNT: $140.15
15809 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 211611
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4350101 4770 140 . 15 TRASH COLLECTION
000181-000001-000206 2306514 2240ST021 3
N96Th St Transfer And Recycling INVOICE
832 Langsdale Ave
Indianapolis, IN 46202 Invoice Date 07/31/2012
wvvw.indywaste.com Invoice No 004770
REPUBLIC Customer No 005000
SERVICES Site No 0000
Page No 1 of 2
Carmel Clay Parks& Recreation Due Date 08/30/2012
1411 E. 116th Street
Carmel, IN 46032 Current Charges Total Amount Due
7AUG 0 C �,T I $140:15 $140.15 .
0 2012 i Please Pay Total Amount Due
Billing Questions? Call 317-917-7300 Ext. 568
-Date -.-,-Code- Description------- - Reference-- - Quantity —- Amount-----
07/19 CA C&D 59170 0.76 39.90
07/19 CA Bill of Lading: 0 0.00
07/19 CA Reference: P03
07/19 HA TIRE 59170 17.00 68.00
07/19 HA Bill of Lading: 0 0.00
07119 HA Reference: P03
07/19 HA TIRE 59170 1.00 15.00
07/19 HA Bill of Lading: 0 0.00
07/19 HA Reference: P03
07/19 {} ENVIRONMENTAL FEE 59170 1.00 10.00
07/19 {} Bill of Lading: 0 0.00
07/19 {} Reference: P03
07/19 }1 FUEL RECOVERY FEE 59170 1.00 7.25
07/19 }1 Bill of Lading: 0 0.00
07/19 }1 Reference: P03
---------- Material Summary ----------
ACCOUNT STATUS
..Current 31=60 D8 s I 61=80 Da s Over 90 Da s= Totai'Amount Due
$140.15 0.00 0.00 0.00 $140.15
-b \L Please return the portion below with your payment. Do not attach check to stub. y 4,
Carmel Clay Parks& Recreation 005000 Page 2 of 2
Date Code Description Reference Quantity Amount
C&D 0.76 39.90
TIRE 18.00 83.00
ENVIRONMENTAL FEE 1.00 10.00
FUEL RECOVERY FEE 1.00 7.25
Total Current Charges =__________> $140.15
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
96th St Transfer and Recycling Terms
15809 Collections Center Drive
Chicago, IL 60693
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/31/12 4770 Trash disposal $ 140.15
Total $ 140.15
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
Voucher No. Warrant No.
96th St Transfer and Recycling Allowed 20
15809 Collections Center Drive
Chicago, IL 60693
In Sum of$
$ 140.15
ON ACCOUNT OF APPROPRIATION FOR
101 -General Fund
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1125 4770 4350101 $ 140.15 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
9-Aug 2012
Signature
$ 140.15 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund