215571 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 359344 Page 1 of 1
' ONE CIVIC SQUARE AYERS BACKFLOW CHECK SERVICE CHECK AMOUNT: $180.00
CARMEL, INDIANA 46032 20 BENNETT ROAD
CARMEL IN 46032 CHECK NUMBER: 215571
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 376752 180 . 00 BUILDING REPAIRS & MA
376752 I=
SOLD TO SHIPPED TO
CAY?'l4U- Ayers Bickflm Check Ser.
ADDRESS ADDRESS 20 Bennett
CITY,STATE,ZIP CITY,STATE,ZIP
575-0752
CUSTOMER ORDER NQ SOLD 13V"{ TERMS DATE
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ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
359344 Ayers Backflow Check Ser Terms
20 Bennett Rd
Carmel, IN 46032
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
12/6/12 376752 Waterpark backflow& repair $ 180.00
Total $ 180.00
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.
359344 Ayers Backflow Check Ser Allowed 20
20 Bennett Rd
Carmel, IN 46032
In Sum of$
$ 180.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#FrITLE AMOUNT Board Members
Dept#
1093 376752 4350100 $ 180.00 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
13-Dec 2012
Signature
$ 180.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund