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216140 01/09/2013
CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1 `` • ONE CIVIC SQUARE NORTH CENTRAL CO-OP CARMEL, INDIANA 46032 PO BOX 299 CHECK AMOUNT: $1,172.88 WABASH IN 46992 CHECK NUMBER: 216140 CHECK DATE: 1/9/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4231300 GT401756 805 . 38 DIESEL FUEL 2201 4231500 GT401756 367 . 50 OIL �O Warsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester Kokomo Huntington Auburn Constantine 574-753-3673 Star City Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667 (00_6 Do Branch Co. MI Hart MI Noble I 877-615-2667 d NE� 7427 DATE 01/03/13 09:30:7 517-278-4561 231-873-2158 765-67 START 0.0 END 386.8 P.O.BOX 299 800-440-2667 317-77 - WABASH, IN 46992 DELIVERY 386.8 GALLONS 4040 SUPER DX-4 BIODIESDISTILLATI ** MULTIPLE DELIVERIES AT SITE CHARGE INVOICE Driver: GT GARY TEETERS Customer: 0000921780 Invoice #: GT 401756 CARMEL STREET DEPT Date: 1/3/013 3400 W 1331ST STREET Time: 08:16 CARMEL, IN 46074 Tros Terms Description Item # Description Legend Quantity Unit Price Ite© Total 02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 228.8000 3.5000 805.38 02 NORMAL CHARGE TERMS 4031 Heater Oil E 98.0000 3.75000 367.50 Legend: Invoice Subtotal: 1,172.88 E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00 Invoice Total: 1,172.88 WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9300 WE APPRECIATE YOUR BUSINFESS!!! Custoaer Signature: x t•l ./l'�-- CUSTOMER VOUCHER NO. WARRANT NO. ALLOWED 20 North Central Co-op IN SUM OF $ P. O.. Box 299 Wabash, IN 46992 $1,172.88 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#1 Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 GT401756 42-315.00 $367.50 1 hereby certify that the attached invoice(s), or 2201 GT 401756 42-313.00 $805.38 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 Friday; January 0 04, 2013 i an a/r Y ;,_rStreet 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)) 01/03/13 GT401756 $367.50 01/03/13 GT 401756 $805.38 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