217064 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00352276 Page 1 of 1
ONE CIVIC SQUARE BREAKERS UNLIMITED
CARMEL, INDIANA 46032 15241 STONY CREEK WAY CHECK AMOUNT: $3,000.00
+� ? NOBLESVILLE IN 46060
CHECK NUMBER: 217064
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 3156161-01 3 , 000 . 00 OTHER EXPENSES
x BREAKERS 15 No Stony Creek Way
Noblesville, IN 46060
UNLIMITED Office 317 776.8817
Fax 317 773.9867
One Call. In Stock. Right Now. breakersunlimited.com
CUSTOMER CODE SHIP /TR I INVOICE NUMBER
CIT666 3156161-01
317-571-2443
O BILL CITY OF CARMEL SHIP CWWTP O
TO: TO:
750 THIRD AVE SW 9609 HAZEL DELL PARKWAY
O CARMEL IN 46032 INDIANAPOLIS IN 46280 O =
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O CUSTOMER P.O. NO. 715-03 lG
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N SHIP I TR I INVOICE NUMBER SLSMN. ORDER DATE TAKER CUSTOMER P.O.NUMBER DATE O
u Y 3156161-01 100 01/30/13 303 715-03 01/31/13 M
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0j X 1 1 * HMCP600L6 EA 3000. 00 3000.00 3 r-
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*** THIS IS YOUR INVOICE *** SUBTOTAL 3, 000.00 Q
MISC.CHARGE M
.CHARGE TELE 0
FREIGHT IN FREIGHT OUT .
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FREIGHT TOTAL
FED./OTHER TAX
NET TERMS: INV 30 DUE: 03/02/13 STATE TAX
*** ORDER COMPLETED *** PAYMENT RECD. -
Please Remit Payment TO: Breakers Unlimited TOTAL AMT DUE
15241 Stony Creek Way 3, 000. 00
Noblesville, IN 46060
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
352276
BREAKERS UNLIMITED Purchase Order No.
15241 Stony Creek Way Terms
Noblesville, IN 46060 Due Date 2/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/7/2013 3156161-01 $3,000.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
.,1a1 j C.
Date Officer
VOUCHER # 126643 WARRANT # ALLOWED
352276 IN SUM OF $
BREAKERS UNLIMITED
15241 Stony Creek Way
Noblesville, IN 46060
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
3156161-01 01-7202-06 $3,000.00
Voucher Total $3,000.00
Cost distribution ledger classification if
claim paid under vehicle highway fund