222396 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1
F ONE CIVIC SQUARE GENERAL SHALE&BRICK
CARMEL, INDIANA 46032 PO Box 5825
CHECK AMOUNT: $421.00
+ CAROL STREAM IL 60197-5825
CHECK NUMBER: 222396
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236200 181868798 421 . 00 CEMENT
General Shale
Brick=®®®
Building The American Dream!
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Invoice: 181868798 Invoice Date: 07/16/2013
Bill To: 279670 Customer PO: SHOP
CITY OF CARMEL
3400 W 131ST STREET Bill of Lading: 172076999
WESTFIELD IN 46074-8267 Goods Issue Date: 07/16/2013
Order: 31618 744 7
Sales Rep: 399
Ship-To:
CITY OF CARMEL Order Loc.: Carmel
3400 W 131ST STREET CARMEL IN
WESTFIELD IN 46074-8267 Phone: 317-846-2566
Mode of Shipment: Customer Pickup 057
Material Material Description Quantity Price Value USD
Batch Number and Description
6099001046 ESSROC BRIMENT GRAY TYPE N 50 BAG 8.42 421.00
Subtotal 421.00
TAX
TOTAL 421.00
LATE PAYMENT CHARGE of 1.5-. PER MONTH.
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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))
07/16/13 181868798 $421.00
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
General Shale and Brick
IN SUM OF $
P. O. Box 5825
Carol Stream, IL 60197-5825
$421.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 181868798 I 42-362.001 $421.00 1 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
i 2013
Str -kqflfC0tWMt?? ner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund