211698 08/14/2012 i�
CITY OF CARMEL, INDIANA VENDOR: 355559 Page 1 of 1
ONE CIVIC SQUARE CULY CONTRACTING,INC
CARMEL, INDIANA 46032 5INDUSTRIAL PARK DRIVE CHECK AMOUNT: $30,911.09
o� PO BOX 29 CHECK NUMBER: 211698
WINCHESTER IN 47394
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 249 30, 911. 09 1052 . 07
CUL Y CONTRACTING, INC.
5 INDUSTRIAL PARK DRIVE
P.O. BOX 29
WINCHESTER,INDIANA 47394
(765) 584-8509 Date: 07/18/2012
Invoice#: 0000000249
Page: 1
To: CITY OF CARMEL UTILITIES For Job: �9S12448T
760 THIRD AVENUE SW CARMEL- 16" LOWERING- 11 I TH& ILLINOIS
AT"1,N: JEI'F CARPENTER
CARMEL,IN 46032-
Quantity Price Amount
T&M INVOICE FOR WORK ORDERED 6/26
1.0000 9,751.0900 LS 9.751.09
AND PERFOR_NIED 6/27
NINITRIALS 8,010.00
1.0000 &010.0000 LS
LABOR
1.0000 13,1 50.0000 I_S
13;150.00
EQU1PIMENT
,.h
lnvoice Totals 09
30.911
0.00
Gross
(J.00
Retention
311.911.119
Tai
T O,1'AL DA31E
nil
--
r + f� WOMMIX I » �
Prescribed by State Board of Accounts
Form No.301(Rev.1995) ACCOUNTS PAYABLE VOUCHER
TO
ADDRESS
Invoice Date Invoice Number Item Amount
I 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
' 19
Signature Title
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.
19 /
7ficer Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ACCT.
NO.
CARMEL, INDIANA
CU A( co Favor Fav Of
ksftQCf
Total Amount of Voucher $
k
Deductions
?Z1 Or—
D
Amount of Warrant
$ 3 /�
Month of 19
. ,
Acct.
VOUCHER RECORD No.
Source of Supply
r Water Treatment
� a Transmission and Dist.
s � § Customer Accounts
Administrative and General
Operation-Maintenance
Utility Plant in Service
Constr.Work in Progress
Materials and Supplies
Customers Deposits
Total
Allowed
Board of Control
Filed
y. Official Title
BOYCE FORMS•SYSTEMS 1-800-382-8702 325