220128 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 355029 Page 1 of 1
ONE CIVIC SQUARE DIRTWORKS LLC
' CARMEL, INDIANA 46032 5925 E 122ND STREET CHECK AMOUNT: $80.00
CARMEL IN 46033 CHECK NUMBER: 220128
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 9766 80 . 00 6360 . 6
Dirtworks, LLC
5925 East 122nd Street Invoice
Carmel, IN 46033 Date°j `rrvoce «-,
Phone # (317)428-8210 Fax # (317)846-0338
4/30/2013 9766
Bill To � � � �Y
\....� 4 z 1
City of Carmel Utilities
3450 West 131st Street
Westfield,IN. 46074
I
rrDu�e'Date
6/1/2013
-
ate�� Q
4/3/2013 Ticket#784640, Shop by#72 1 20.00 20.00
Same by#70 1 20.00 20.00
4/8/2013 Ticket#172365, 111th St by#72 1 20.00 20.00
4/12/2013 Ticket#322484,Job Site by#70 1 20.00 20.00
If Your Account is 60 Days Past Due----Your Account Will be Closed until
Payment Is Received! Total $80.00
Balance Due - -$g°-.°°
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
3555029
DIRTWORKS LLC Purchase Order No.
5925 EAST 122ND STREET Terms
CARMEL, IN 46033 Due Date 5/11/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/11/2013 9766 $80.00
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
_5-7/3 G���ek.
Date Officer
VOUCHER # 131559 WARRANT # ALLOWED
3555029 IN SUM OF $
DIRTWORKS LLC
5925 EAST 122ND STREET
CARMEL, IN 46033
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9766 01-6360-06 $80.00
Voucher Total $80.00
Cost distribution ledger classification if
claim paid under vehicle highway fund