214327 11/07/2012 *f CITY OF CARMEL, INDIANA VENDOR: 354857 Page 1 of 1
0 ONE CIVIC SQUARE HOOSIER PORTABLE RESTROOMS INC CHECK AMOUNT $200.00
CARMEL, INDIANA 46032 2201 E 99TH ST
INDIANAPOLIS IN 46280 CHECK NUMBER: 214327
CHECK DATE. 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 6640 200 00 OTHER CONT SERVICES
Hoosier Portable Restrooms, Invoice
License #29-031/33/35
2201 E 99th Street Date Invoice#
Indianapolis, IN 46280 10/15/2012 6640
Bill To Customer Phone Customer Fax
Carmel Fire Department 317-409-3538 317-571-2615
Keith Freer
2 Civic Square
Carmel. IN 46032
Project PO No Terms
Evacuation Emergency Due upon receipt.please.
Item Service Dates Quantity Rate Amount
Standard Unit(s)Serviced-SF Oct 15 Evacuation Emergency 2 10000 20000
Total $20000
Our Phone# Our Fax#
(317)844-6919 (317)844-6919
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))
6640 $20000
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
$20000
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO ACCT#/TITLE I AMOUNT Board Members
1120 I 6640 I 43-509 00 I $200 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
NOV — 6 2W
! Fire Chief M
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund