214435 11/07/2012 CITY OF CARMEL, INDIANA VENDOR: 362878 Page 1 of 1
0 ONE CIVIC SQUARE T B A WAREHOUSE CHECK AMOUNT: $639.00
CARMEL, INDIANA 46032 2425 E 30TH ST
INDIANAPOLIS IN 46218 CHECK NUMBER: 214435
CHECK DATE: 1117/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 03KX2264 639. 00 6500004
TBA North Invoice
309 Gradle Dr. No. 03KX2264
Carmel, IN 46032
317-574-1957 FAX: 317-574-1982 IIIIIII�IIIIIII`I`IIII�IIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIII
Page 1
14:54:51 Oct 16 2012
CUSTOMER NUMBER Invoice NUMBER Invoice DATE PACKING SLIP TERMS WHSE
314 03KX2264 10/16/12 03SL4416001 NET 10TH 030
BILL TO: SHIPPED TO:
CITY OF CARMEL WATER CITY OF CARMEL WATER
3450 W. 131ST ST. 3450 W. 131ST ST
CARMEL, IN 46074 CARMEL, IN 46074
IIIIIIl I�l I��IIII111�lIl1���lIII�111��11llllll�lllll - � -
Dept: 002 CITY OF CARMEL WATER Contact: /317-733-2853 Route: NORTH Direction:
YOUR P.O.NUMBER ORDER DATE CSR SHIPPED VIA CARTONS OPER
10/16/12, 14:54:49 400003 JIM RATLIFF N NORTH A 403
UNIT ORDER BACK INV LIST CORE NET NET EXT
ITEM DESCRIPTION BIN QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
****ON THE WAY OUT
BUYOUT. Part is not
returnable after 15 days
from purchase****
BUY 15W4055GAL MECHANICS PRIDE OIL NONE EA 1 0 1 799.00 0.00 639.00 0.00 639.00
TOTAL PURCHASE
TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
639.00 799.00 639.00 0.00 0.00 0.00 639.00 0.00 639.00
2.08% service charge on past due accounts(25% per annum).
Core returns must be in original box. All new returns must
be resalable. No return after 30 days without invoice.
=---------------------------------------------------------
VOUCHER # 122557 WARRANT # ALLOWED
354275 i IN SUM OF $
TBA WAREHOUSE-INDY
2425 E 30TH STREET s
INDIANAPOLIS, IN 46218
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
1 ;
Board members
i
S
i
PO# INV# ACCT# AMOUNT Audit Trail Code
03KX2264 01-6500-04 $319.50
03KX2264 01-6500-05 $319.50
Voucher Total $639.00
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
354275
TBA WAREHOUSE-INDY Purchase Order No.
2425 E 30TH STREET Terms
INDIANAPOLIS, IN 46218 Due Date 10/29/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/29/201: 03KX2264 $639.00
I 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 Officer