217934 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00353173 Page 1 of 1
ONE CIVIC SQUARE A F C INTERNATIONAL INC
CARMEL, INDIANA 46032 PO BOX 894 CHECK AMOUNT: $248.39
715C SWALMOND ST CHECK NUMBER: 217934
DEMOTTE IN 46310
CHECK DATE: 3/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 37431 248 . 39 OTHER EXPENSES
AFC International Inc Invoice
PO Box 894
715C SW Almond St
DeMotte IN 46310 Date Invoice#
IMT IPA
N AL. INC f
2/26/2013 37431
Bill To Ship To
City of Carmel City of Carmel
Jeff Cooper Jeff Cooper/#S13491
9609 Hazel Dell Pkwy 9609 Hazel Dell Pkwy
Indianapolis IN 46280 Indianapolis, IN 46280
P:O. No: Terms Due Date. Rep Ship ; Via
S13491 Net 30 3/28/2013 2/26/2013 UPS
Qty, Shipped B/0. Cat. No'. 1� Description Price Amount
5 5 0 008-3012-150 15' Tygon tubing w/male Luer fitting 47.50 237.50
(QRAE/QRAE Plus/VRAE)
1 1 0 Shipping Shipping & Insurance Charges 10.89 10.89
Tracking No 1z6e51330368813998
Thank you for your order.We appreaciate your business.If you have any questions,please contact us at
1.800.952.3293 or fax 219.987.6826.Returns subject to a restocking charge.No returns will be accepted without
prior authorization.In states other than Indiana,AFC is not registered to collect taxes. If taxes are due on this sale
you will be obliged to pay them directly to the various taxing authorities.
REMIT TO: — -REMIT-WIRE TRANSFERS-TO: ' Subtotal $248.39
AFC International Inc JP Morgan Chase
PO Box 894 Account# 134446783 Sales Tax(7.0%) $0.00
DeMotte IN 46310 Bank#074000010
800.952.3293 or 219.987.6825 SWIFT#CHASUS33 Total $248.39
FEIN 36-3836857
VOUCHER # 135063 WARRANT # } ALLOWED
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00353173 IN SUM OF $
AFC INTERNATIONAL INC
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PO BOX 894 + ;�
DEMOTTE, IN 46310
4
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
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Board members
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PO# INV# ACCT# AMOUNT Audit Trail Code
37431 01-7200-02 $248.39
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Voucher Total $248.39
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
00353173
AFC INTERNATIONAL INC Purchase Order No.
PO BOX 894 Terms
DEMOTTE, IN 46310 Due Date 3/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/7/2013 37431 $248.39
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