215280 12/11/2012 CITY OF CARMEL, INDIANA VENDOR: 366309 Page 1 of 1
ONE CIVIC SQUARE BIOSOLUTIONS, INC CHECK AMOUNT: $141.04
CARMEL, INDIANA 46032 1350 W SOUTHPORT ROAD SUITE C 291
INDIANAPOLIS IN 46217 CHECK NUMBER: 215280
CHECK DATE: 12/1112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 120412-1 141 . 04 GARAGE & MOTOR SUPPIE
t>t In v® ice
Date: December 4,2012
Invoice#: 120412-1
Payment Terms: Net 30
To: Carmel Street Dept.
Attn: Bonnie Callahan FOB Origin
3400 West 131st Street
Carmel, IN 46074
Purchase Order:Phone 11/27/12
- Ordered by: Jeff Stewart
® e in . -- ---
1 8008-005 BioRem-2000 Surface Cleaner(5 gallon) $ 115.00 $ 115.00
1 Shipping Charge: $ 26.04 $ 26.04
'Total: $ 141.04
Please remit to: BioSolutions, Inc.
1950 E. Greyhound Pass
Suite 18-189
Carmel, IN 46033
Thank you for your business!
VOUCHER NO. WARRANT NO.
BioSolutions ALLOWED 20
IN SUM OF $
1350 W. Southport Road Suite C #291
Indianapolis, IN 46217
$141.04
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I 120412-1 I 42-321.00] $141.04 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
Frida' J�De�ber 07, 2012
Street Commiss& r
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))
12/04/12 120412-1 $141.04
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