219059 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 367012 Page 1 of 1
ONE CIVIC SQUARE TEST GAUGE&BACKFLOW SUPPLY
' CARMEL, INDIANA 46032 5644 S MERIDIAN ST SUITE E CHECK AMOUNT: $600.00
INDIANAPOLIS IN 46217 CHECK NUMBER: 219059
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 0011632 600 . 00 OTHER EXPENSES
TEST GAUGE & BACKFLOW SUPPLY Invoice
5644 S MERIDIAN ST Phone 1-317-786-8990 Invoice 0011 632
SUITE E Fax 1-317-614-7607
INDIANAPOLIS, IN 46217 E-Mail IN-FRANCHISE @TESTGAUGE.N Terms DUE UPON RECEIPT
Date 3/2912013
Order 0012211
Bill To Ship To
CARMEL WATER CARMEL WATER
3450 WEST 131 ST STREET 3450 WEST 131 ST STREET
CARMEL, IN 46074 CARMEL, IN 46074
Purchase Order Reference Ship Via UPS Tracking# Sales rep
MB32713 Customer Pickup RPM
Product Quantity Description Price Disc% Amount
845-5 1 Ea MID-WEST INSTRUMENTS 845-5 5 VALVE 600.00 Ea 0.00 $600.00
BACKFLOW PREVENTER TEST KIT
SERIAL# 1 Ea SN#03132968 trade for SN 187261 Midwest 0.00 Ea 0.00 $0.00
830
20% Trade In Discount for scrapped Midwest
Gauge.
•Any invoice past 30 days will receive a finance charge of 1.5% 1 Sub-total $600.00
•Any invoice past 45 days will cause your account to be placed as inactive. No transactions will be
processed until payment is received.
•Any invoice past 60 days will be sent to our collections agency with a 1.5%finance charge added
and a'35%collections charge to the entire balance.
Total $600.00
VOUCHER # 131279 WARRANT # ALLOWED
367012 IN SUM OF $
TEST GAUGE & BACKFLOW SUPPLY
5644 S MERIDIAN ST
SUITE E
INDIANAPOLIS, IN 46217
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO # INV# ACCT# AMOUNT Audit Trail Code
0011632 01-6200-06 $600.00
Voucher Total $600.00
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
367012
TEST GAUGE & BACKFLOW SUPPLY Purchase Order No.
5644 S MERIDIAN ST Terms
SUITE E Due Date 4/3/2013
INDIANAPOLIS, IN 46217
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/3/2013 0011632 $600.00
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
Date Officer Officer