212368 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 359498 Page 1 of 1
` ONE CIVIC SQUARE SHELBY MATERIALS
0 CHECK AMOUNT: $713.56
CARMEL, INDIANA 46032 P o BOX 242
SHELBYVILLE IN 46176 CHECK NUMBER: 212368
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4236100 421998 713 . 56 SAND
INVOICE
CUSTOMER NO. DATE INVOICE NO. PAGE
TM
M A T E F2 1 A L-
"The Concrete and Aggregate Experts"0 B RO01 08/20/2012 4 219 9 8 1
317-398-4485•FAX 317-398-2727
BROOKSHIRE GOLF CLUB Send remittance to:
CITY OF CARMEL
12120 BROOKSHIRE PKWY Shelby
P.O.Box 242
CARMEL, IN 46033 Please attach top part Shelbyville, Indiana 46176
with your remittance. Detach Here
JOB NUMBER-JOB LOCATION-ADDRESS PER
DATE PRICE TICKET NO. -QUANTITY° UNIT DESCRIPTION UNIT. TAX TOTAL "
000201 GOLF COURSE
PO NUMBER: G-98
08/16 032-490542 23 . 10 TN TOP DRESSING SAND 22 . 250 513 . 98
08/16 032-490542 23 . 10 TN DELIVERY CHARGE 8 . 000 184 . 80
08/16 032-490542 1 . 85 TN FUEL SURCHARGE 8 . 000 14 . 78
JOB TOTAL LINE 713 . 56
Date Vic ` Init, -2
Account # 403wob $
__Account # $
Account # r
, $
+
\ Account-#
t
INVOICE - 713 . 56
AMOUNT DUE .,-►
TERMS:NET 30 DAYS-THERE WILL BE A FINANCE CHARGE OF 2.00%PER MONTH(24%PER
ANNUM)ON ALL ACCOUNTS PAST 30 DAYS.ALL ACCOUNTS,WITHOUT PRIOR APPROVAL,
WHICH HAVE OUTSTANDING BALANCES OVER 90 DAYS,WILL BE TEMPORARILY PLACED ON
C.O.D.THE ACCOUNT WILL REMAIN ON A C.O.D.BASIS UNTIL BALANCE IS PAID OR SUITABLE
ARRANGEMENTS ARE MADE WITH THE CREDIT DEPARTMENT.ALL ACCOUNTS TURNED
OVER FOR COLLECTION WILL INCUR REASONABLE ATTORNEY FEES AND COURT COSTS TO
BE PAID BY THE PURCHASER WITH PROPER VENUE AS SHELBY COUNTY.
CC750392(4101) Shelby Supply(Rev.11/08)
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))
08/20/12 421998 Sand $713.56
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
Shelby Materials
IN SUM OF $
P.O. Box 242
Shelbyville, IN 46176
$713.56
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 421998 I 42-361.00 I $713.56 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
Friday, August 24, 2012
Director, Brookshir Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund