212474 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 356009 Page 1 of 1
ONE CIVIC SQUARE R G A/HOOSIER RUBBER&TRANSMISS10
CARMEL, INDIANA 46032 3905 EAST PROGRESS STREET CHECK AMOUNT: $56.67
NORTH LITTLE ROCK AR 72114 CHECK NUMBER: 212747
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 F13814-001 56 . 67 TRANSPORTATION EXPENS
INVOICE
MAIL REMITTANCE TO: ENTERING OFFICE INVOICE NUMBER TRAIN
CODE
HOOSIER RUBBER & TRAN. F13814-001 DI
R�� 2002 LAFAYETTE RD. INVOICE DATE PAGE
INDIANAPOLIS IN 46222 08/24/12 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.
0UANT17Y »: ;::c::#:; ;:::.
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TOTAL':::_::;
..'''''. ....:......O.UN�,a/o, ANEOUNT:i<
10 6 6 PPA200 7.8000 46.80
2 MALE ADAPTER DIX EA
X FEMALE NPT
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FOLD
CUST. NO. ORDER DATE TERR PC ORD Written By DATE SHIPPED WHSE AMOUNT 46.80
TC125 08/21/12 TD 70 S GL F 08/24/12 70
FRGHTIINSIHNDL 9.87
Carrier: UPS FOB: SP,FNA,PREPAID ORIGINAL INVOICE
SALES TAX 00
Tracking: '
Terms of Payment: NET 30 DAYS INVOICE TOTAL 56.67
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 COOPER Mark No.
s CARMEL UTILITIES s CARMEL WASTE WATER
0 760 3RD AVENUE SW H 9609 HAZEL DELL PARKWAY
— - — p—SUITE-1 10 p
T CARMEL IN 46032 T INDIANAPOLIS IN 46280
0 0
VOUCHER # 125632 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
F13814-001 01-7502-06 $56.67
Voucher Total $56.67
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 9/5/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/5/2012 F13814-001 $56.67
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