212257 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 359984 Page 1 of 1
` ONE CIVIC SQUARE INDIANA GOLF CAR
CARMEL, INDIANA 46032 CHECK AMOUNT: $237.80
1770 B EAST 266TH STREET
ARCADIAIN 46030 CHECK NUMBER: 212257
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 4321 237 . 80 EQUIPMENT REPAIRS & M
Indiana Golf Car, Inc. Invoice
1770 B E 266th
Date Invoice#
Arcadia, IN 46030
8/13/2012 4321
Bill To Ship To
BROOKSHIRE G.C. BROOKSHIRE G.C.
12120 BROOKSHIRE PKWY. 12120 BROOKSHIRE PKWY.
CARMEL,IN 46033 CARMEL,IN 46033
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 8/13/2012
Quantity Item Code Description Price Each Amount
1 102289801 CLAMP-LEAF SPRING 9.10 9.10
3 103628701 SPRING ASM,FRONT, 1 LEAF 44.70 134.10
1 103528801 KIT,BRAKE CABLE,PREC UPGRADE 47.90 47.90
1 ,102509301 REAR LEAF SPRING,ELEC 46.70 46.70
IZI
ate
1� Init. l�fl
Account# 43R0 $
Account
Account# $
Account#_ $
$237.80
Total
.1._.
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))
08/13/12 4321 Repair Parts $237.80
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.
ALLOWED 20
ndiana Golf Car, Inc.
IN SUM OF $
1770 B E 266th
4rcadia, IN 46030
$237.80
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
'O#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
1207 I 4321 I 43-500.00 I $237.80 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
Thu, aiitiimr iF gn12
Director, Brookshir b..
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund