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222090 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 201250 Page 1 of 1 4J� ONE CIVIC SQUARE MID STATE TRUCK EQUIP CORP CHECK AMOUNT: $304.47 CARMEL, INDIANA 46032 11020ALLISONVILLE RD FISHERS IN 46038 CHECK NUMBER: 222090 CHECK DATE: 7/17/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4237000 72681 239 . 00 REPAIR PARTS 2201 4237000 72685 65 . 47 REPAIR PARTS MID-STATE TRUCK EQUIPMENT Invoice 11020 Allisonville Road Invoice Number: Retail#: 001104675-001-0 72681 Fishers, IN 46038 Mid-Sale: quipmenc 'rrdr Invoice Date- Phone: 317.849.4903 Fax : 317.849.6441 www.mid-statetruck.com 7/1/2013 Bill To Ship To CARMEL STREET DEPARTMENT 3400 West 131 Street WESTFIELD, IN 46074 H andlin 4 :harmeWdded to Credit Customer P.O. No. Terms Card orders over$500.00: 2.5% on Visa, MIC, AMEX&Discover NET 25 Days Sales Rep ID Shipping Method Ship Date Due Date .................... ...............................------------------- ...................................... ......... ......................... ............................. TMB P 7/1/2013 7/26/2013 ... ............------ i Qty Item Code Description i Price Ea. Extension ......................... ............ ............ ............................ ........................ . TRAIL FX NERF BARS STAINLESS STEEL FORD 23900. 1 !PARTS 1 239.00 F350 REG CAB ................ ...... Serial# Serial# Subtotal $239.00 Sales Tax (7.0%) $0.00 Received by Total Invoice Amount $239.00 Payment Received $0.00 Check#/Aut Orization Code: Balance Due $239.00 r1rnil I ank you for your business! MID-STATE TRUCK EQUIPMENT Invoice 11020 Allisonville Road Invoice Number: Retail#: 001104675-001-0 72685 Fishers, IN 46038 41d' -ScalloTruck Eqijipmenc LiadcznlpGin Invoice Date: Phone: 317.849.4903 Fax : 317.849.6441 www.mid-statetruck.com 7/2/2013 Bill To Ship To CITY OF CARMEL ONE CIVIC SQUARE CARMEL, IN 46032 Handling�charge added to C Customer P.O. No. Terms Card orders over$500.00: 2.5%on Visa, MIC,.AMEX& Discover DIXIE CHOPPER NET 25 Days Sales Rep ID Shipping Method Ship Date Due Date ........... ..................... ­.­'..._­.......... -..................... ................. .......... ....... cis cust. pick-up 7/2/2013 7/27/2013 ................ I Qty i Item Code I Description Price Ea. Extension ......................... ...... ............ ........... ............... ......... ........... .............. 2168140 Filter- Hyro Zinga 40 Micron 17.45 34.90 I l2010B88W Belt- B88 Wrapped B88 30.57: 30.57 Serial# Serial# Subtotal $65.47 Sales Tax (7.0%) $0.00 Total Invoice Amount $65.47 Receivej�. Payment Received $0.00 Check#/Authorization Code: L Balance Due $65.477 r1rnif i ank you for your business! Prescribed by State Board of Accounts City Form No.201 (Rev.1995) j 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 i Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 07/01/13 72681 $239.00 07/02/13 72685 $65.47 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 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. Mid-State Truck Equipment ALLOWED 20 IN SUM OF $ 11020 Allisonville Road Fishers, IN 46038 $304.47 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 72681 42-370.00 $239.00 1 hereby certify that the attached invoice(s), or 2201 72685 42-370.00 $65.47 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 Wed sda y 10 13 Ssfr&F@gfWB1Pkr Title Cost distribution ledger classification if claim paid motor vehicle highway fund