213499 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 354857 Page 1 of 1
ONE CIVIC SQUARE HOOSIER PORTABLE RESTROOMS INC CHECK AMOUNT: $300.00
' ,CARMEL INDIANA 46032
�•�j+ 2201E 99TH ST
INDIANAPOLIS IN 46280 CHECK NUMBER: 213499
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
851 5023990 6378 300 . 00 OTHER EXPENSES
Hoosier Portable Restrooms, Invoice
License 429-031/33/35
2201 E. 99th Street Date Invoice#
Indianapolis, IN 46280
8/24/2012 6378
Bill To Customer Phone Customer Fax
Carmel Fire Department 317-409-3538 317-571-2615
Keith Freer
2 Civic Square
Carmel, IN 46032
Project P.O. rho. Ter is
Safety Day Due upon receipt,please.
Item Service Dates Quantity Rate Amount
Standard Unit(s)Serviced-SE September 29,2012 4 50.00 200.00
Portable Handwashing Station 2 50.00 100.00
It is a pleasure working with you!
Total $300.00
Our Phone# Our Fax#
(317)844-6919 (3 17)844-6919
'rescribed by State Board of Accounts City Form No.201(Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
kn invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
vhom, 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))
6378 $300.00
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
Hoosier Portable Restrooms
IN SUM OF $
2201 E. 99th Street
Indianapolis, IN 46280
$300.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 6378 1 120-851.00 I $300.00 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
OCT
� b
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund