216810 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
0 ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $1,258.80
CARMEL, INDIANA 46032 PO BOX 299
WABASH IN 46992 CHECK NUMBER: 216810
CHECK DATE: 1/2912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 GT401839 616 . 00 GARAGE & MOTOR SUPPIE
2201 4231300 GT401884 433 . 67 DIESEL FUEL
2201 4232100 GT401884 209. 13 GARAGE & MOTOR SUPPIE
NORMWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Kokomo Huntington Auburn Constantine 574-753-3673 Star City
CalL 1100-720-0550 Call: 800-234-0573 800-807-3673 Call 574-224-2667
Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-675-2538
P.O.BOX 299 800-440-2667 317-773-0870
WABASH, IN 46992
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921720 Invoice #: GT 401839
CAME STREET DEPT Date: 1/14/2013
34H W 131ST STREET Time: 12:28
CARMEL, IN 46074
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 5574MI ADV PREM THE—DRUM 55.0000 11.2'0000 616.80
Legend: Invoice Subtotal: 616.00
E=Metered, T=Taxable, *centered by Hand Indiana Sales Tax On: 0.00 ..... 0.60
Invoice Total: 616.00
_ WARNING — PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIGS. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CUSTOMER
® 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
CO-OP Branch Co. MI Hart MI Noblesville 877-615-2667
517-278-4561 231-873-2158 765-67538 7527 DATE 01/18/13 14:39:26
P.O. BOX 299 800-440-2667 317-773CM START 0.0 END 179.6
WABASH, IN 46992 GROSS DELIVERY 179.6 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000921720 Invoice #: GT 401884
CARMEL STREET DEPT Date: 1/18/2013
3400 W 131ST STREET Time: 13:27
CAME, IN 46074
Trms Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 125.7M 3.45M 433.67
62 NORMAL CHARGE TERMS 4031 Heater Oil E 53.9M 3.88000 209.13
Legend: Invoice Subtotal: 642.80
E=Metered, T=Taxable, *centered by Hand Indiana Sales Tax On: 0.00 ..... 0.80
Invoice Total: 642.80
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 CHEMTREC AT 1-800424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature: CA�A
CUSTOMER
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF$
P. O.. Box 299
Wabash, IN 46992
$1,258.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 GT 401839 42-321.00 $616.00 1 hereby certify that the attached invoice(s), or
2201 GT401884 42-321.00 $209.13 bill(s) is (are) true and correct and that the
2201 GT401884 42-313.00 $433.67
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, January 25, 2013
—k2
Street Commissioner
r�
C. TifIeS` I
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))
01/14/13 GT 401839 $616.00
01/18/13 GT401884 $209.13
01/18/13 GT401884 $433.67
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
120
Clerk-Treasurer