212352 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 356009 Page 1 of 1
ONE CIVIC SQUARE R G A/HOOSIER RUBBER&TRANS MISS10
CARMEL, INDIANA 46032 3905 EAST PROGRESS STREET CHECK AMOUNT: $208.58
' NORTH LITTLE ROCK AR 72114
CHECK NUMBER: 212352
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 F11712-001 208 . 58 TRANSPORTATION EXPENS
INVOICE
MAIL REMITTANCE TO: ENTERING OFFICE INVOICE NUMBER TRAN
CODE
HOOSIER RUBBER & TRAN. F11712-001 DI GA
[MR 2002 LAFAYETTE RD. INVOICE DATE PAGE'
INDIANAPOLIS IN 46222 08/09/12 1
AN EMPLOYEE OWNED COMPANY
3905 East Progress Street
Any different or additional terms that may be embodied in your purchase order are hereby objected to. If your order is not an
North Little Rock, AR 72114 acceptance of our proposal,this will operate as an acceptance of your order only in the event you agree to the terms hereof.
The terms and conditions contained above and attached shall apply.
OUAN-TtTY
LiltEf paT MiJP11BEFt UAifT Q) MEA$UfiE Uit1iT RRIGEXTENI3E#:
T03AL i3A.C.IC : THIS
NU P D£SCAiPTIpN PAQDUCT: AfSCOUN;�6 AMOiJAfT
10 19 19 GTT-300 9.8700 187.53
150PSI T/T GBLH FT
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FOLD
CUST. NO. ORDER DATE TERR PC ORD Written By DATE SHIPPED WHSE AMOUNT 187.53
TC125 08/08/12 TD 70 S RJL 08/09/12 70
FRGHT/INSIHNDL 21 .05 I
Carrier: SPEC DISP FOB: SP,FNA,PREPAID ORIGINAL INVOICE
SALES TAX 00
Trackina:
i
Terms of Payment: NET 30 DAYS INVOICE TOTAL 208.58
Please Pay This Amount
ORDER ISSUED IN: INDIANAPOLIS
Note New Remit To Address: PHONE: 317/634-3976
3905 East Progress Street
North Little Rock, AR 72114
Customer PO No. JEFF Mark No.
s CARMEL UTILITIES s CARMEL WASTE WATER
0 760 3RD AVENUE SW H 9609 HAZEL DELL PARKWAY
D SUITE 110 p
T CARMEL IN 46032 T INDIANAPOLIS IN 46280
-0 - 0
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
350590
RGAMOOSIER RUBBER &TRANSMISSON Purchase Order No.
3905 E. Progress Street Terms
North Little Rock, AR 72114 Due Date 8/23/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/23/2012 F11712-001 $208.58
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
Date Officer
VOUCHER # 125556 WARRANT # ALLOWED
350590 IN SUM OF $
RGA/HOOSIER RUBBER & TRANSMIS,
3905 E. Progress Street
North Little Rock, AR 72114
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
F11712-001 01-7502-06 $208.58
Voucher Total $208.58
Cost distribution ledger classification if
claim paid under vehicle highway fund