213526 10/09/2012 ±.F CITY OF CARMEL, INDIANA VENDOR: 366481 Page 1 of 1
ONE CIVIC SQUARE JEM BLASTING AND PAINTING LLC
CARMEL, INDIANA 46032 PO BOX 305 CHECK AMOUNT: $8,226.00
=� erc BEECH GROVE IN 46107-305 CHECK NUMBER: 213526
ftON GO
CHECK DATE: 1019/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 921 8, 226 . 00 OTHER EXPENSES
JEM Blasting and Painting, LLC Invoice
PO Box 305
Date Invoice#
Beech Grove, IN 46107-305
9/23/2012 921
Bill To D
Carmel Waste Water Treatment OCT
9609 Hazel Dell Parrkway
Indianapolis IN 46280
ORIGINAL
P.O.P.O. No. Terms Project
S13198
Quantity Description Rate Amount
Sandblasting and painting Clarifier 92 8,226.00 8,226.00
Total 32,904.00
Paid 8,226.00
-8,226.00
Remaining Balance 16,452.00
Contact Person Jeff Cooper
_0 K to Pay
-31
-06
Total $9,226.00
VOUCHER # 125803 WARRANT # ALLOWED
366481 J IN SUM OF $
JEM BLASTING & PAINTING LLC j
PO BOX 305
BEECH GROVE, IN 46107-305
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
921 01-7362-06 $8,226.00
Voucher Total $8,226.00
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
366481
JEM BLASTING & PAINTING LLC Purchase Order No.
PO BOX 305 Terms
BEECH GROVE, IN 46107-305 Due Date 10/2/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/2/2012 921 $8,226.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
orrect and I have audited same in accordance with IC 5-11-10-1.6
�J
Date Officer