219024 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 360381 Page 1 of 1
ONE CIVIC SQUARE SANTAROSSA MOSAIC&TILE CO INC
CARMEL, INDIANA 46032 PO Box 664043 CHECK AMOUNT: $289.00
'r ? INDIANAPOLIS IN 462664043 CHECK NUMBER: 219024
CHECK DATE: 4/912013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 1303047 289 . 00 BUILDING REPAIRS & MA
L
.I- -
%SANTAROSSA MOSAIC & TILE CO., INC. INVOICE
TILE—TERRAZZO—MARBLE—PRECAST TERRAZZO—CARPET—VINYL TILE o e • e •
PHONE: (317) 632-9494 • FAX(317)631-5567
www.santarossa.com
REMIT TO: SANTAROSSA MOSAIC&TILE CO., INC. • — — • e 1303047
P.O.Box 664043
Indianapolis, IN.46266-4043
29503 1303047
e •;
MONON PARK 2-9650
ATTN: MATTHEW/ACCOUNTS PAYABLE 13023 TC
1235 CENTRAL PARK DRIVE EAST
CARMEL, INDIANA 46032
TERMS: NET 30 DAYS
RE: TIME AND MATERIAL WORK, PO#29503
1
JOB COMPLETE PER WORK ORDER #30565 FOR THE SUM OF: 289.00
Purchase
Desrripi;' ,K�Lt1a
P.O. 2 503 P CJF
G.L.# IN 3-+5
36010 0
Budget
Line ClEIVED
beacr
Purchaser_ Cale
Approva' ----- o,�;,----- MAR 2 6 2013
BY:
PLEASE PAY THIS AMOUNT: $ 289.00
Late payments will be subject to late charges of 1112%interest per month and reasonable attorney fees for Santarossa should the matter be placed with an attorney for collection.
DIRECTALL NON-PAYMENT CORRESPONDENCE TO:SANTAROSSA MOSAIC&TILE CO,INC. P.O.BOX 18181 INDIANAPOLIS,IN 46218
Nu 3USbb
SANTAR®SSA EXTRA WORK ORDER
MOSAIC &TILE CO., INC.
Tile • Terrazzo • Marble • Carpet * Vinyl PHONE DAO�R9E�,`
2707 Roosevelt Avenue • P.O. Box 18181 Indianapolis; Indiana 46218 ORDERTAKENBY ! CUSTsMERRS ORDER NUMBER
ph-. 317.632.9494 • tx: 317.631.5567
❑ DAY WORK ❑ CONTRACT TRA
(Rpj:CE'ro_ Pa r JOB NAME
10 pre
_G V On Q l l JOB LOCATION
JOB NUMBER 7
RATE REG. RATE 1.5 RATE 2X/NT
DATE LABOR REGULAR HOURS AMOUNT 1.5x HOURS AMOUNT 2X / NT HOURS AMOUNT
P/9
I
i
I
I
TOTAL LABOR TOTAL LABOR TOTAL LABOR
DESCRIPTION MATERIALS/EQUIPMENT/DELIVERY PRICE AMOUNT
rG�i'G Y ,
TOTAL MATERIALS/EQUIPMENT
BY SIGNING THIS FORM YOU ARE AUTHORIZING THE WORK AT THE NUMBER OF HOURS AND THE RATE LISTED ABOVE. I TOTAL LABOR
PLEASE REMIT ZEbI,d�
mh PAYMENT OR CHANGE ORDER TOTAL MAT./EQUIP.
WORK ORDERED BY-OWNER'S REPRESENTATIVE IN 30 DAYS
FOR ALL EXTRA WORK,
1.5%CHARGES ON TAX
ALL OVERDUE BILLS. 7 =gq
SIGNATURE I Hereby Acknowledge The Completion Of The Requested Work r
OFFICE-1 S1!CIISTOMFR COPY-2NIl/FORMEN/INSTALLERS-3RD
ACCOUNTS PAr YABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
360381 Santarossa Mosaic & Tile Co., Inc. Terms
P.O. Box 664043
Indianapolis, IN 46266-4043
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
3/20/13 1303047 Repair bamboo flooring MCC East 29503 $ 289.00
Total $ 289.00
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.
360381 Santarossa Mosaic& Tile Co., Inc. Allowed 20
P.O. Box 664043
Indianapolis, IN 46266-4043
In Sum of$
$ 289.00
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/T1TLE AMOUNT Board Members
Dept#
1093 1303047 4350100 $ 289.00 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
4-Apr 2013
124 d-*Mnuz,
Signature
$ 289.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund