214762 11/20/2012 *f CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
ONE CIVIC SQUARE NORTH CENTRAL CO-OP
CARMEL, INDIANA 46032 PO BOX 299 CHECK AMOUNT: $2,243.19
WABASH IN 46992
CHECK NUMBER: 214762
CHECK DATE: 11/2012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT401304 940 . 60 DIESEL FUEL
1207 4231400 GT401304 879 . 72 GASOLINE
2201 4231300 GT401368 422 . 87 DIESEL FUEL
®mm Warsaw Wabash Peru Goshen ans ort Angola Fremont Lo Plymouth Rochester
9 Logansport Y
Cmm%u Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
co-w Branch Co. MI Hart MI Noble j✓il 877-615-2667
517-278-4561 231-873-2158 765-67 1148 7132 DATE 11/13/12 14:36:18
P.O. BOX 299 800-440-2667 317-776 START 0.0 END 115.1
WABASH, IN 46992 GROSS DELIVERY 115.1 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921720 Invoice #: GT 401368
CARMEL STREET DEPT Date: 11/13/2012
3400 W 131ST STREET Tice: 13:19
CAME, IN 46074
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 80.6000 3.62000 291.77
02 NORMAL CHARGE TERMS 4031 Heater Oil E 34.5000 3.80000 131.10
Legend: Invoice Subtotal: 422.87
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 422.87
WARNING — PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CUSTOMER
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P. O.. Box 299
Wabash, IN 46992
$422.87
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I GT 401368 I 42-313.001 $422.87 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
Thursday, November 15, 2012
` f r 1 i, ,l
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor 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 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))
11/13/12 GT 401368 $422.87
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
HGMTWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
D Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
877-615-2667
Branch Co. MI Hart MI Noble 'I la DATE 11/06/12 09:49:13
517-278-4561 231-873-2158 765-67 - 8
P.O. BOX 299 800-440-2667 317_77 _ START 0.0 END 304.5
WABASH, IN 46992 DELIVERY 304.5 GALLONS
4011 87 E-10 PLUS GASOLINE 1
** MULTIPLE DELIVERIES AT SITE **
SALE 7078 DATE 11/06/12 09:40:56
COUNT: START 0.0 END 244.7
GROSS DELIVERY 244.7 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
** MULTIPLE DELIVERIES AT SITE **
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice #: GT 401304
BROOKSHIRE GOLF CLUB Date: 11/6/2012
CITY OF CARMEL Time: 08:29
12120 BROOKSHIRE PKWY
CARMEL, IN 46033—
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4011 87 E-10 PLUS E 304.4M 2.89000 879.72
State Road Tax 0.18000 54.79
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 244.7000 3.62000 885.81
Legend: Invoice Subtotal: 1,820.32
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 1,820.32
WARNING — PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
U STO M ,E R
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P.O. Box 299
Wabash, IN 46992
$1,820.32
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1207 I GT 401304 I 42-313.00 $940.60 1 hereby certify that the attached invoice(s), or
1207 GT 401304 42-31#.00 $879.72 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
Friday, November 09, 2012
Vf Director, Brookshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor 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 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))
11/06/12 GT 401304 Fuel I $940.60
11/06/12 GT 401304 Fuel $879.72
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