214801 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 00353191 Page 1 of 1
ONE CIVIC SQUARE ROAD SOLUTIONS INC
" CARMEL, INDIANA 46032 PO BOX 42387 CHECK AMOUNT: $1,088.25
INDIANAPOLIS IN 46242-0387 CHECK NUMBER: 214801
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 0005752-IN 1, 088 . 25 OTHER MAINT SUPPLIES
NVOICE RO�ADs> ROAD SOLUTIONS, INC.
SOL6:T&S 5616 Progress Road• P.O. Box 42387• Indianapolis, IN 46242-0387
INC, Phone 317/243-3248• Fax 317/244-8461 •Toll Free 888/888-3615
BILL NO. c?R 0:-,1C,0 SHIP NO.
SOLD SHIP
TO CARMEL STREET DEPARTMENT TO [ CARMEL STREET DEPARTMENT
3400 W. 131ST STREET 3400 W. 131ST STREET
ATTN: JEFF STEWART ATTN; DAVE
WESTFIELD IN 46074 WESTFIELD IN 46074
)ATE CUST.P.O.NO. TERR, SHIPPED VIA TRANS NO. INVOICE NO.
111 / ,?:"12
DAVE PR4)c� 0004P1P t�0 5752—IN
QUANTITY UM PRODUCT N0. DESCRIPTION PRICE TOTAL
ORDERED SHIPPED BACK ORD.
3 PI 126?—?-i0 RC T—4 5I LANE PEPdETRTP�G 36 .75 1 ,OeS.25
TERMS: TAX FREIGHT TOTAL
NET 15 DAYS .00 .00 1 ,088.25
ORIGINAL
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))
11/07/12 0005752-IN $1,088.25
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
Road Solutions
IN SUM OF $
P. O. Box 42387
Indianapolis, IN 46242-0387
$1,088.25
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 1 0005752-IN 1 42-389.001 $1,088.25 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
s JII ursday, love ber 15, 2012
uw.,�/
r'
Street Commission
^u .Gl v
Titl IIII IIIJJI 11
e
Cost distribution ledger classification if
claim paid motor vehicle highway fund