213365 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 00351018 Page 1 of 1
ONE CIVIC SQUARE ASPHALT MATERIALS INC CHECK AMOUNT: $402.48
CARMEL, INDIANA 46032 PO BOX 635474
CINCINNATI OH 45263-5474 CHECK NUMBER: 213365
()QH G
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236300 40494776 402 .48 BITUMINOUS MATERIALS
INVOICE
ASPHALT MATERIALS, INC. Invoice: 40494776
INDIANAPOLIS, INDIANA Invoice Date: 9/22/2012 12:00:OOAM
Customer PO
Invoice Total $ 402.48
CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
Plant Location: INDIANAPOLIS, INDIANA For billing questions call: 317-228-8211 Paqe 1 of 1
� MISte i tion;.P
9117/20121 799754 AE-150 0.41 TN 468.0000 191.88
9119120121 799819 AE-150 0.45 TN 468.0000 210.60
Material: 402.48
Freight:
Tax: 0.00
Total: 402.48
Detach and include with remittance Please remit 40494776
PO Box 635474
Cincinnati, OH 45263-5474
Amount Remitted
CITY OF CARMEL Invoice Date: 9/22/2012 12:00:OOAM
ONE CIVIC SQUARE Due Date: 10/22/2012 12:00:OOAM
CARMEL IN 46032 Customer PO
2%Per Month will be charged if payment is not received by due date Pavment Terms NET 30
Customer No> 582 Invoice Total $402.48
4049477600000582 9/22/2013 200040248 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 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))
09/22/12 40494776 $402.48
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
Asphalt Materials, Inc.
IN SUM OF $
P. O. Box 635474
Cincinnati, OH 45263-5474
$402.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 40494776 I 42-363.001 $402.48 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, bct8ber 05, 2012
:f
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund