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221582 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 358389 Page 1 of 1 ONE CIVIC SQUARE JACK DOHENY SUPPLIES INC CHECK AMOUNT: $553.54 �`. CARMEL, INDIANA 46032 PO BOX 609 NORTHVILLE MI 48167 CHECK NUMBER: 221582 CHECK DATE: 7/212013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 C46627 553 . 54 OTHER EXPENSES hy4, a Remittance Address: �� �D ® �ffi Jack Doheny Supplies, Inc. comp es Phone (248)349-0904 P.O. Box 609 ( ) 349-2774 {i'orlds Largest Distributor ujSewer Cleaning. Fax 248 Northville, Michigan 48167 Air Handling and Street Sweeping Equipment° www.dohenysupplies.com Customer I N V O I C E Invoice P g CARME03 C46627 1 6/19/13 Sold To Ship To CARMEL WASTEWATER TREATMENT CARMEL WASTEWATER TREATMENT ATTN: PAUL ARNONE ATTN: BLAINE MALLABER 9609 HAZEL DELL PARKWAY 9609 HAZEL DELL PARKWAY INDIANAPOLIS IN 46280 INDIANAPOLIS IN 46280 7Soo, o-a. Ship Via WILL CALL FOB JDS WHITESTOWN IN FACILITY ---------------------------------------------------------------------------------- Br Trk Make Model Serial Equipment Meter Sls Customer P. O. --------------------------------------------------------------------------------- 007 LET S13567 --------------------------------------------------------------------------------- Ordr Ship B/O Description List Each Amount ---------------------------------------------------------------------------------- Taken By JOHN BENGE Opened 6/19/13 Shipped 6/14/13 2 2 ZZ 607140-02 76. 10 76. 10 152. 20 5"LED AMBER STROBE 2 2 ZZ RSA03ZCR 82. 87 82. 87 165. 74 TIER 3 MINI AMB. STR 4 4 ZZ SL65AO 58. 90 58. 90 235. 60 AMBER STROBE-AMBER TOTAL PARTS 553. 54 - -INDIANA -MUNICIPALITIES . 00 VISIT OUR WEBSITE @ www. dohenysupplies. com WE APPRECIATE YOUR BUSINESS --------------------------------------------------------------------------------- Total 553. 54 ------------------------------------------------------------------------------------ I SEE REVERSE SIDE FOR SALE TERMS AND CONDITIONS SALE TERMS AND CONDITIONS The sale terms and conditions of Jack Doheny Supplies, inc., d/b/a Jack Doheny Companies and its affiliates (..Doheny::) which can be found at WV,,%N dohenysupplies.com (the "Doheny Sale Term, and Condi`ions"), are hereby incorporated into and made a part of this invoice and shall be construed with and as an integral part of this invoice to the same extent as if set forth; verbatim herein. This invoice and the parties' entire relationship} hereunder shall be governed exclusively by the Doheny Sale Terms and Conditions. Doheny hereby objects to and rejects any proposal fo3 additional, different or inconsistent term=s or any attempt by Seller to vary in any degree any of the terms of the Doheny Sale Torras and Conditions, but any such proposals shall not operate as a rejection of this offer by you, unless such variances are in the terms of the description, q,-±antity, prig: or delivety schedule of the goods oi, services, and this offer shall be deemed accepted ';y you without said additional, different or inconsistent terms if this invoice shall be deer:aed an acceptance of a Prior offer by, Seller, such acceptance is limited tr: the express 3er s set forth herein, including the Doheny Sale Terr:-rs and Condit;_;rts. Prescribed by State Board of Accounts Form No 301-S(Rev.1997) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount I 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 Mo. Day Yr. Signature Title 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. Mo. Day Yr. Officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WASTEWATER UTILITY ANOT. CARMEL, INDIANA Jock bA-VAI/ Favor Of Po M)( /coq Total Amount of Voucher $ Deductions I - o -O 53S Amount of Warrant $ Month of Yr Acct. VOUCHER RECORD No. Collection System Pumping Treatment&Disposal Customer Accounts Administrative&General Reclaimed Water Treatment Reclaimed Water Distribution Total Allowed Board Members Filed BOYCE FORMS•SYSTEMS 1-800-382-8702 325