214838 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 362878 Page 1 of 1
f ONE CIVIC SQUARE T B A WAREHOUSE CHECK AMOUNT: $20.28
CARMEL, INDIANA 46032 2425 E 30TH ST
INDIANAPOLIS IN 46218 CHECK NUMBER: 214838
CHECK DATE: 11/2012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01KY2077 20 .28 TRANSPORTATION EXPENS
TBA Warehouse Invoice
2425E 30th Street No. 01 KY2077
Indianapolis, IN 46218
317-923-2222 FAX: 317-923-2233
Page 1
08:46:12 Nov 05 2012
CUSTOMER NUMBER Invoice NUMBER F] DATE PACKING SLIP TERMS WHSE
314 O1 KY2077 11/05/12 O 1 S N/16173001 NET 10TH 010
BILL TO: SHIPPED TO:
CITY OF CARAMEL WATER � � CITY OF CARMEL WATER
3450 W. 131ST ST. 3450 'W 131ST ST
CARAMEL, IN 46074 �� CARMEL, IN 46074
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Dept: 002 CITY OF CARMEL WATER Contact: /317-733-2853 Route: NORTH Direction:
a
YOUR P.O.NUMBER ORDER DATE CSR SHIPPED VIA CARTONS OPER
STOCK 11/05/12, 07:06:56 300007 BRIAN HALPER N NORTH A 0 307
ORDER BACK INV LIST CORE NET NET EXT
ITEM DESCRIPTION UNIT QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
STOCK TODAY
CHE WS GAL-20 CASE 6/1 240/SKID EA 12 0 12 3.09 0.00 1.69 0.00 20.28
TOTAL PURCHASE TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT 'FAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
20.28 37.08 20.28 0.00 0.00 0.00 20.28 0.00 20.28
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 # 122716 WARRANT # ALLOWED
354275 IN SUM OF $
TBA WAREHOUSE-INDY
2425 E 30TH STREET
INDIANAPOLIS, IN 46218
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
01KY2077 01-6500-05 $20.28
Voucher Total $20.28
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 11/12/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/12/201: 01 KY2077 $20.28
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