218779 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 363613 Page 1 of 1
ONE CIVIC SQUARE BOB'S CO2
CARMEL INDIANA 46032 1750 W HUNTSVILLE ROAD CHECK AMOUNT: $60.00
,
PENDLETON IN 46064
CHECK NUMBER: 218779
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4239040 7406 60 . 00 FOOD & BEVERAGES
����� �� �.�.�. DELIVERY TICKET No. 7406
"I've Got Gas"
1750 W. Huntsville Road
Pendleton, IN 46064 f
Date: ' ' ` '
317-989-9262 • 765-776-6463
t.
ID! Qty. Unit Description&Hazard Class Item tt Cylinders Volume Unit. Extended Amount
Ship Ship Return Weight Amount {
MY
2
3
4
5
6
8
9
10
t xd W..
IMPORTANT
��uB�Tdra�� _ I
PLEASE READ CAREFULLY THE TERMS AND CONDITIONS OF SALE WHICH APPEAR ON THE
REVERSE SIDE OF THIS DOCUMENT. ALL SALES ARE SUBJECT TO SUCH TERMS AND
CONDITIONS. CUSTOMER SIGNATURE HEREON VERIFIES SHIPPED AND RETURNED RENTAL
CYLINDER COUNT. 01 gg
s...x ter./.s :z 1
TERMS AND CONDITIONS: THE CUSTOMER HEREIN CONSENTS TO AND ACCEPTS THE ABOVE PRODUCTS SUBJECTTO ALL OF THE CONDITIONS ASSET
FORTH ON REVERS
ESIDE HEREOF.AND THE EXISTING CONTRACT BETWEEN BOTH PARTIES.
X Rec*''d,_By�(Sig na,.e)� �._ Date �! T/
X b. � � r _
Pay From Delivery Ticket Shipped By
WHITE COPY-OFFICE YELLOW COPY-CUSTOMER
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))
04/05/13 I 7406 I CO2 $60.00
I 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
Bob's CO2, L.L.0
IN SUM OF $
1750 West Huntsville Road
Pendleton, IN 46064
$60.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 7406 I 42-390.40 I $60.00 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
Friday, April 05, 2013
Director, Brookshire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund