219313 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 092000 Page 1 of 1
ONE CIVIC SQUARE FASTENAL COMPANY
CARMEL, INDIANA 46032 PO BOX 1286 CHECK AMOUNT: $207.50
WANONA MN 55987-1286
CHECK NUMBER: 219313
CHECK DATE: 412412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350100 ININ810795 207 . 50 BUILDING REPAIRS & MA
® Remit to INVOICE
FASTEAML Fastenal Company
P.O. Box 1286 Page 1 of 1
Winona, MN 55987-1286
Date Invoice No.
Cust.No. ININ80003 For billing questions 04/05/2013 ININ810795
Cust. P.O. 430 Alpha Drive,Suite 300
Job No. WESTFIELD, IN 46074 Due Date Invoice Total
Contract No. QPA#11179 Phone 317-867-5259 05/05/2013 207.50 USD
Sold To
Fax 317-867-5394
Ship To
CARMEL STREET DEPT. CARMEL STREET DEPT.
3400 W 131ST ST 3400 W 131ST ST
WESTFIELD, IN 46074-8267 WESTFIELD, IN 46074
I
This Order and Document is subject to the"Terms of Purchase" posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 5 5 0 PC Board Red REPL fo WEIN1088 12728-00313 4,150.0000 207.50
Received By Tax Exemption Subtotal 207.50
0031201550-020 G Shipping&Handling 0.00
Comments IN State Tax 0.00
County Tax 0.00
Contact:Eric Russell City Tax 0.00
Total 207.50
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product,you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
Invoice: ININ810795 Cust: ININ80003
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 N I N 810795 $207.50
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
Fastenal
IN SUM OF $
P. O. Box 978
Winona, MN 55987-0978
$207.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I ININ810795 1 43-501.001 $207.50 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
Fr Apr 1 2013
VVVVW
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund