216916 01/29/2013 .f CITY OF CARMEL, INDIANA VENDOR: 316200 Page 1 of 1
% 0 ` ONE CIVIC SQUARE UTILITY SUPPLY CO INC.
CARMEL, INDIANA 46032 6310 S HARDING ST CHECK AMOUNT: $99.96
INDIANAPOLIS IN 46217 CHECK NUMBER: 216916
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1084348 99 . 96 OTHER EXPENSES
INVOICE
UTILITY SUPPLY COMPANY
U Branch: 03 USC NW INDY INVOICE
S 6310 SOUTH HARDING STREET 1084348
.0 INDIANAPOLIS, IN 46217 Invoice Date Pagc
US 1/15/2013 14:30:43 1 1 of I
ORDER NUMBER
317-783-4196 1090166
Bill To: Ship To:
CARMEL WASTEWATER DEPARTMENT CARMEL WASTEWATER DEPARTMENT
760 3RD AVE SW 9609 HAZEL DELL PARKWAY
CARMEL, IN 46032 INDIANAPOLIS, IN 46280
US US
At In: LISA KEMPA Ordered By:JEFF COOPER
Customer ID: 100766
PO Number Term Description Net Due Date Disc Due Date DiscountAntount
CALVIN Net 30 DAYS 2/14/2013 2/14/2013 0.00
Order Date Pick Ticket No Primary Salesrep Name Taker
1/15/2013 14:20:39 1092287 DOUG KARST ZSTIERWALT
Quantities Pricing
Item ID UOM Unit Ectended
Ordered Shipped Remaining UOM Item Description Price Price
Unit Size p Unit Size
Carrier: CUSTOMER PICK UP Tracking#:
1.00 1.00 0.00 EA IOX6GJSTEE EA 99.9646 99.96
1.0 10X6 SDR-35 GJ TEE BELL X BELL 1.0000
Total Lines: l SUB-TOTAL: 99.96
TAX: 0.00
A FINANCE CHARGE computed at a periodic rate of 1 1/2%per month(18% AMOUNT DUE: 99.96
ANNUAL PERCENTAGE RATE)is applied to PAST DUE ACCOUNTS OVER 30 DAYS.
ORIGINAL
VOUCHER # 126540 WARRANT # ALLOWED
316200 IN SUM OF $
UTILITY SUPPLY CO INC.
6310 S HARDING ST
INDIANAPOLIS, IN 46217
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1084348 01-7202-06 $99.96
7
Voucher Total $99.96
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
316200
UTILITY SUPPLY CO INC. Purchase Order No.
6310 S HARDING ST Terms
INDIANAPOLIS, IN 46217 Due Date 1/23/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/23/2013 1084348 $99.96
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have Jaudited same in accordance with IC 5-11-10-1.6
Date Officer