223256 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 367407 Page 1 of 1
5 1.
ONE CIVIC SQUARE USF HOLLAND INC CHECK AMOUNT: $222.09
CARMEL, INDIANA 46032 27052 NETWORK PLACE
o� CHICAGO IL 606731270 CHECK NUMBER: 223256
CHECK DATE: 8/1312013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1016408335 222 . 09 OTHER EXPENSES
Original HOLLAND(HMES) lnv®ice
Holland 750 EAST40TH ST Freight Bill# Amount
P.0.BOX 9021 U.S.Dollars
HOLLAND M149422-9021 1016408335 $222.09
A ti ric Worldwide C";mpeny
Invoice Mailing Address O Payment Due Net 15 Days
MB 01 001 107 23860 H 11 A Shipment Date 07/15/13
111111111111111 11111-I r I I I I I I I I'I I I I'I"I I I I"I l l l r l�l l l'l l l l l l'I Charges COLLECT
CARMEL WWTP
BLAINE MALLABER S13659
9609 HAZEL DELL PKWY
INDIANAPOLIS IN 46280-2935
BOL Number
800
D 80090349
P.O.Number
JUL 2 6 2013 4197474
By Mail Payments
USF Holland Inc.
Shipper 016289 Consignee 27052 Network Place Chicago IL 60673-1270
JEFFREY MFG CARMEL WWTP IL ii
2307 MADEN DR BLAINE MALLABER S13659 — 'I Correspondence °
MORRISTOWN TN 378132898 9609 HAZEL DELL PKWY • olland
INDIANAPOLIS IN 462802935 750 East 40th St
0/. M 3 � 2 . O 6 P.0.Box 9021
// Holland MI 49422-9021
D eta i I of Charges Invoicing Questions
Pieces Description Class Weight Rate Charges Phone (866)465-5263
1 SKIDS CHAINS, BELTING OR SPROCKET, OIT Web Site hollandregional.com
MACHINE FINISHED OR SILENT, STEEL OR the
MALLEABLE IRON 1-93940 55.0 122 M 344.07 Any attachments you received g on
past will now be printed starting on
__ DISCOUNT 172.04 the reverse side of this invoice. _
FSC 29.10% NATL AVG FUEL COST IS 382.2.8 8 50.06
Total Pieces Total Weight Total Amount Due
Thank ou for using Holland!
1 122 222..09 y
Mn
Holland FED.TAX ID N
� 38-0655940
--------------
VOUCHER # 136145 WARRANT # ALLOWED
367408 IN SUM OF $
USF HOLLAND INC
27052 NETWORK PLACE
CHICAGO, IL 60673-1270
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1016408335 01-7362-06 $222.09
i
i
Voucher Total $222.09
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
367408
USF HOLLAND INC Purchase Order No.
27052 NETWORK PLACE Terms
CHICAGO, IL 60673-1270 Due Date 8/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/7/2013 1016408335 $222.09
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
Date Officer