HomeMy WebLinkAbout221169 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
ONE CIVIC SQUARE NORTH CENTRAL CO-OP
s ti' CHECK AMOUNT: $2,154.53
CARMEL, INDIANA 46032 Po Box zss
WABASH IN 46992 CHECK NUMBER: 221169
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT402868 1, 623 . 62 DIESEL FUEL
1207 4231400 GT402868 530 . 91 GASOLINE
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Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
Branch Co. MI Hart MI Noblesville 877'615-2667
P.O. BOX 299 517-278-4561 231-873-2158 765-67EA98 4302 DATE 06/03/13 12:22:04
800-440-2667 317-77'j-1 Ax 7.0
WABASH, IN 46992 COUNT: START 0.0 END 153.0
GROSS DELIVERY 153.0 GALLONS
4011 87 E-10 PLUS GASOLINE 1
Date_ Init. ** MULTIPLE DELIVERIES AT SITE
Acco..,of # $ SALE 8251 DATE 06/03/13 12:11:56
Acco U n t ' COUNT: START 0.0 END 253.1
---- $ GROSS DELIVERY 253.1 GALLONS
Account #
$ 4040 SUPER DX-4 BIODIESDISTILLATI
Account # $ # MULTIPLE DELIVERIES AT SITE
i
CHARGE INVOICE
Driver: 6T GARY TEETERS
Customer: 0000918936 Invoice #: ST 402868
BROOKSHIRE GOLF CLUB Date: 6/3/2013
CITY OF CARMEL Time: 11:56
12120 BROOKSHIRE PKWY
CARMEL, IN 46033-
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4011 87 E-10 PLUS E 153.0000 3.29000 503.37
State Road Tax @.IBM 27.54
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 253.161013 3.54000 895.97
02 NORMAL CHARGE TERMS 5574301 ADV HD DEO 15W40-DRU 55.0000 13.23000 727.65
Legend: Invoice Subtotal: 2,154.53
E=Metered, T=Taxable, *--Entered by Hand Indiana Sales Tax On: 0.09 ..... 0.W
Invoice Total: 2,154.53
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHENTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CUSTOMErin_�
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))
06/03/13 GT 402868 Diesel Fuel $1,623.62
06/03/13 GT 402868 Gasoline $530.91
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
North Central Co-op
IN SUM OF $
P.O. Box 299
Wabash, IN 46992
$2,154.53
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 GT 402868 42-313.00 $1,623.62 1 hereby certify that the attached invoice(s), or
1207 GT 402868 42-_3/4.0b $530.91
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
Monday, June 17, 2013
14n, X d_/
Director, Broo hire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund