220981 06/18/2013 a- CITY OF CARMEL, INDIANA VENDOR: 363723 Page 1 of 1
`• ONE CIVIC SQUARE CARDINAL INDIANA,INC
CARMEL, INDIANA 46032 PO BOX 816 CHECK AMOUNT: $4,790.00
BLOOMINGTON IN 47402 CHECK NUMBER: 220981
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350900 1 4 , 790 . 00 OTHER CONT SERVICES
CARDINAL-INDIANA, INC. INVOICE
P.O. BOX 816
BLOOMINGTON, IN 47402
INVOICE DATE: 6/5/2013
INVOICE NO: 1
BILL TO:
CARMEL STREET DEPT. PERIOD:
3400 W. 131ST. CONTRACT DATE:
CARMEL, IN. 46074
STATE CONTRACT/JOB# MAIN ST. BRI...
G.C.'S JOB#:
CARDINAL'S JOB#:
ITEM NO. DESCRIPTION QTY UNIT BID PRICE QTY THIS EST QTY TO DATE PRIOR AMO... CURRENT A...
MAIN ST. BRIDGE REPAIR 4,790.00 100.00% 100.00% 4,790.00
OF DAMAGED COATING
TOTAL THIS INVOICE $4,790.00
PAYMENTS/CREDITS $0.00
BALANCE DUE $49790.00
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))
06/05/13 1 $4,790.00
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.
ALLOWED 20
Cardinal Indiana, Inc.
IN SUM OF $
P.O. Box 816
Bloomington, IN 47402
$4,790.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I 1 I 43-509.001 $4,790.00 1 hereby certify that the attached invoice(s), or
1 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
F c y, J 14, 2013
Street Commissionlrr
I+reet Commissiener
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund