223163 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367402 Page 1 of 1
e ONE CIVIC SQUARE QUALITY WRECKER SERVICE INC CHECK AMOUNT: $375.00
CARMEL, INDIANA 46032 2318 N MONROE ST
o� ALBANY GA 31701 CHECK NUMBER: 223163
CHECK DATE: 8/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 180775 375 . 00 OTHER EXPENSES
3 (.-7 Yea
.,INVOICE# ,.
1: .775
. Providing""Dedicated'Logistics Today;Tomorrow and-Beyond "
2318;N.MONROE'STREET -.ALBANY,':'
;GEORGIA 31701:.
(229).:4,35-6003 "
RO#: PO#:
','CUSTOMER:. /i�y
:'REC'D.CALG�'• 'jr'' DEPT+D',. "-.-ARR..SCENE,'. ':DEPT'D ARR.TERM,",
p MAKE.- MOOEL` YEAR : TAG#.`
COLOR VIN_
#. `
TRUCK OUT _ PICKUP - MILES PULLED.
`TRUCK,IN -DESTINATION ` - :?AMOUNT, ,
,.'. . : AMOUNT . . '
i
I,.,• ♦.DOLLIES ;•.-
" D RIVE.SHAFT ..;' ... ,� �Z•S. -
! - -AMOUNT
• STORAGE' - - DAYS:- .. - ..
AMOUNT - - -
i �` /11ov�,1L 2c�2yr 4ou �'
G
,. TOTAL.' .',:• ,
'DAMAGE OR;COM ENTS',
eklf', �'•l R'.k
'DRIVER -TRUCK -SHIFT# _
"'OFFICER OR',PERSONS AUTH:,TO:HAVE VEHICLE TOWE_D:. CASE#,,. _
-=1 I-HAVE•RECEIVED'A80VE NAME•VEHICLE'AND CONTENTS-AND.'HAVE:NO COMPLAIN_TS:OR:CLAIMS AGAINST QUALITY''`. -
WECKER,SERVICE:. "
-
CUSTOMER SIGNATUREA THE UNDERSIGNED DO HEREBY CERTIFY THAT,I'AM LEGALLY.AUTHORIZED,- ' --DATE`
__.. _ . .. _ - ..
- AND ENTITLEO,TO TAKE,POSSESSION'OF THE VEHICLE DESCRIBED ABOVE AND,ALL PERSONAL
PROPERTY•THEREIN•1-HAVE RECENED AND'AL•L PERSONAL PROPERTY IN SATISFACTORY`
"CONDITION.,
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
367402
QUALITY WRECKER SERVICE, INC. Purchase Order No.
2318 N. MONROE STREET Terms
ALBANY, GEORGIA 31701 Due Date 8/6/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/6/2013 180775 $375.00
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
eAl
Date Officer
VOUCHER # 136133 WARRANT # ALLOWED
367402 IN SUM OF $
QUALITY WRECKER SERVICE, INC.
2318 N. MONROE STREET
ALBANY, GEORGIA 31701
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
180775 01-7362-06 $375.00
Voucher Total $375.00
Cost distribution ledger classification if
claim paid under vehicle highway fund