215950 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 358688 Page 1 of 1
` ONE CIVIC SQUARE AGRO CHEM
CARMEL, INDIANA 46032 2045 S WABASH STREET CHECK AMOUNT: $56.24
WABASH IN 46992 CHECK NUMBER: 215950
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 IN00530112 56 . 24 REPAIR PARTS
AGRO CHEM, INC. Invoice Date Invoice#
AGRO CH M 2045 S WABASH STREET 12/17/2012 IN00530112
d WABASH, IN 46992
Phone: 800-686-5680
Fax: 888-281-4321
www.agrochem.com
Bill To Ship To
CITY OF CARMEL INDIANA CITY OF CARMEL INDIANA
ONE CIVIC SQUARE 3400 WEST 131 STREET
CARMELJN 46032 CARMELJN 46032
— --•STATEMENTS-SEN T BI=MONTHLY-'PLEASE-PAY-FROrvI-IiiVOICr -
P.O. Number Rep Ship Via Terms Due Date
5 12/17/2012 UPS NET 30 DAYS 1/16/2013
Ordered Shipped B/O Item Code Description Price Each Amount
4 4 0 XR1 1008VS TEEJET SPRAY TIP XR 5.15 20.60
4 4 0 XR11006VS TEEJET SPRAY TIP XR 5.15 - 20.60
8 8 0 256121NYR QJ CAP/BLACK EPDM GSKT 0.76 6.08
1 1 0 UPS SHIPPING 8.96 8.96
Total $56.24
VOUCHER NO. WARRANT NO.
Agro Chem Inc ALLOWED 20
IN SUM OF $
2045 S. Wabash Street
Wabash, IN 46992
$56.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I IN00530112 I 42-370.001 $56.24 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
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St e t C rnrnissi of,er
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))
12/17/12 I N 00530112 $56.24
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
120
Clerk-Treasurer