214297 11/07/2012 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
ONE CIVIC SQUARE GENERAL SHALE&BRICK
CARMEL, INDIANA 46032 PO Box 5826 CHECK AMOUNT: $103.68
CAROL STREAM IL 60197-5825
CHECK NUMBER: 214297
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 181733589 103 . 68 MATERIALS & SUPPLIES
General Shale
Brick M W®
Building The American Dream
.. . ; ....:. ::::.::.;.>:.....:::.
Invoice: 181733589 Invoice Date: 10/26/2012
Bill To: 279670 Customer PO: WATER DEPARTMENT
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 171931210
WESTFIELD IN 46074-8267 Goods Issue Date: 1.0/26/2012
Order: 315361730
Sales Rep: 399
Ship-To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074-8267 �Q Phone: 317-846-2566
Mode of Shipment: Customer Pickup / 057
Job: PALCED BY MATT n
'ICJ
Material Material Description Quantity Price Value USD
Batch Number and Description
6099010275 4 X 8 X 16 SOLID BLOCK 108 EA 0.96 103.68
Subtotal 103.68
TAX
TOTAL 103.68
LATE PAYMENT CHARGE of 1.5% PER MONTH.
PLEASE RETURN THIS PORTION WITH YOUR PAYMENT
Accnt#: Customer Name Invoice-Date Invoice Amount Due
279670 CITY OF CARMEL 10/26/2012 181733589 103.68
Remit To: GENERAL SHALE BRICK, INC
PO Box 5825
CAROL STREAM IL 60197-5825
Terms: Take discount of $2.07 If paid on or before 11/25/2012 NET 45 DAYS. _
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
358385
GENERAL SHALE BRICK Purchase Order No.
PO BOX 5825 Terms
CAROL STREAM, IL 60197-5825 Due Date 11/2/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/2/2012 181733589 $103.68
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 Offic
VOUCHER # 122669 WARRANT # ALLOWED
358385 IN SUM OF $
GENERAL SHALE BRICK
PO BOX 5825
CAROL STREAM, IL 60197-5825
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
181733589 01-6200-06 $103.68
Voucher Total $103.68
Cost distribution ledger classification if
claim paid under vehicle highway fund