222218 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 361174 Page 1 of 1
ONE CIVIC SQUARE WORRELL CORPORATION
CARMEL, INDIANA 46032 305 SOUTH POST ROAD CHECK AMOUNT: $2,763.23
' INDIANAPOLIS IN 46219-7900
«o„� CHECK NUMBER: 222218
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 239928 2 , 763 . 23 OTHER EXPENSES
• �_ o o o L
Invoice Date Invoice No.
305 south post Rood 07/02/2013 0239928
Indionopolis, IN 46419-7900 certified as o
Women Business Enterprise
(317)895-9708 the state of Indona and the Terms
City of Indionopolis frNLBE Programs
www.worrellcorp.com Net 30 Days
Sold To Shipped To WCO
CITY OF CARMEL WORRELL CORPORATION
WATER-WASTEWATER UTILITIES City of Carmel - CCR Insert
760 3RD AVE SW 305 S POST RD
CARMEL, IN 46032 INDIANAPOLIS, IN 46219
II ,I,IIIIIIIIII,flll{ Ilffl11 JAMIE FOREMAN
Sates customer Job Ship Spped Person J Worrell leo.No. JAMIE FOREMAN No. 087951 Date 07/02/2013 UPS GROUND
COC-INCCR 28,000 CCR Annual Report, Insert I 95.36 M 2,670.08
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Freight: 93.15
Saes Tuv:
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A FINANCE CHARGE of 2%per month(24%ANNUAL PERCENTAGE RATE)will be applied to all PAST DUE accounts. TOTAL DUE 2,763.23
All claims or returns must be made within 30 days of receipt and require a return authorization.
All invoices are payable in U.S. Funds. Thank you for your continued business.
VOUCHER # 132079 WARRANT # ALLOWED
361174 IN SUM OF $
WORRELL CORPORATION
305 SOUTH POST ROAD
INDIANAPOLIS, IN 46219-7900
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
239928 01-6750-08 $2,763.23
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Voucher Total $2,763.23
Cost distribution ledger classification if
claim paid under vehicle highway fund
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
361174
WORRELL CORPORATION Purchase Order No.
305 SOUTH POST ROAD Terms
INDIANAPOLIS, IN 46219-7900 Due Date 7/9/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/9/2013 239928 $2,763.23
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
S(/.3 ✓bt.- 1<I -
Date Officer