217804 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 353874 Page 1 of 1
ONE CIVIC SQUARE ROGERS&CO OF INDIANA, INC
CARMEL, INDIANA 46032 CHECK AMOUNT: $1,031.29
6364 WESTFIELD BLVD
INDIANAPOLIS IN 46220 CHECK NUMBER: 217804
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 07086 1, 031 .29 REPAIR PARTS
R O GE R S & COO of Indiana,Inc. CUSTOMER. 07086
6364 WESTFILED BLVD. INDIANAPOLIS,IN 46220 THIS SUP MUST ACCOMPANY INVOICE NO.
PHONE:(317)255-3171 rwww.rogerspools.net ALL CLAI AND RETURNED GOODS
O S7 Ci� l ^�. H NAME �t4
L c I� A-e � IJ I
11 ADDRE
D 3 q00 c,� , i 3 I s,_+ ��f�. P
o2sT. e(�� z-4 (o0�y o ciTY �73 _ 6703 srarE
DATE SALESMAN ❑CASH ❑REC.ACCT. P IA ❑Ppd TERMS CUSTOMER
-y�- (� 1— ORDER NO.
13 1 CHARGE ❑RETD.MDSE. -\ ❑Coll. -
- - --DEPT-. - / FO.B- 3 Q
❑C.O.D. ❑
QUANTITY DESCRIPTION PRICE ACCOUNT
fc ,—
5- X— 0- 'J"'tD TC. 10 ( 5 d s(E (z (�K
N)d� �a0 e �-eCkL valuf- Ls'� �o f13,`7$ 5`"6? qO
C s Ro) 16 . 13
. f
SALES TAX
RECEIVED BY TOTAL
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))
02/14/13 07086 $1,031.29
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Rogers and Company of Indiana
IN SUM OF $
6364 Westfield Blvd.
Indianapolis, In 46220
$1,031.29
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 1 07086 1 42-370.001 $1,031.29 1 hereby certify that the attached invoice(s), or
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
Thur y, uary 21, 2013
Awi 'bSommis er
mmloa�c�nvr
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund