216502 01/15/2013 -----
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------------------
""'• CITY OF CARMEL, INDIANA VENDOR:
g ONE CIVIC SQUARE 360025
CARMEL, INDIANA 46032 UNIFIRST CORPORATION Page 1 of
4201 INDUSTRIAL BLVD
INDIANAPOLIS IN 46254 CHECK AMOUNT. 50
$ 6.40
CHECK NUMBER: 216502
DEPARTMENT CHECK DATE:
ACCOUNT PO NUMB 1/15/2013
ER INVOICE
651 NUMBER
5023990 AMOUNT DESCRIPTION
651 5023990 0732454 0734066 240 . 95 OTHER EXPENSES
265 .45 OTHER EXPENSES
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INVOICE DATE PAYMENT TERMS PURCHASE ORDER CONTRACT
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INVOICE NUMBER 082 0732454 REMIT TO: Un i F i F s t Corporation
1 i INVOICE DATE 1 /02;,13 42101 INDUSTRIAL BLVD
CUSTOMER# (BILL TO) 809566 I INDIANAPOLIS IN 46254
A/R NUMBER R`I`E# H4690
,A CUSTOMER CITY OF' CARMEL UT'ILITI +
PAYMENT AMOUNT
0820732454Z
- Please Detach an.d Return With Payment -
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INVOICE DATE PAYMENT TERMS PURCHASE ORDER CONTRACT
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Y OF C:ARMEL UTILITIES 6CITY OF CARMEL UTILITIES
HAZEL DELI_ PARKWAY $4 609 HAZEL DELL. PARKWAY
IANAPOLIS IN 46280 OINDIANAPOLIS IN 46260
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DEFE CHARGYE: 10. 00
INVOICE SUB-TOTAL 240. 9S
• TOTAL SERVICE CHANGES
i AMOUNT DUE
M THIS IS YOUR ONLY INVCE- NET 30 DAYS. PLEASE SIGN
t lk i SOIL PICK UP COUNT SH PT OT 1140
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SERVICE HEREIN RENDERED IS PURSUANT TO A WRITTEN CONTRACT CUSTOMER COPY
WITH UNIFIRST CORPORATION OR UNIFIRST HOLDINGS,INC.
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
360025
UNIFIRST CORPORATION Purchase Order No.
4201 INDUSTRIAL BLVD Terms
INDIANAPOLIS, IN 46254 Due Date 1/10/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/10/2013 0734066 $265.45
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
Date Officer
VOUCHER # 126481 WARRANT # ALLOWED
360025 IN SUM OF $
UNIFIRST CORPORATION
4201 INDUSTRIAL BLVD
INDIANAPOLIS, IN 46254
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
0734066 01-7360-02 $265.45
O''IV, 1
506 C)
Voucher Total _$
Cost distribution ledger classification if
claim paid under vehicle highway fund