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223478 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 358385 Page 1 of 1 ONE CIVIC SQUARE GENERAL SHALE&BRICK CHECK AMOUNT: $7.50 CARMEL, INDIANA 46032 PO BOX 5825 CAROL STREAM IL 60197-5825 CHECK NUMBER: 223478 CHECK DATE: 8127/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4236200 181884955 7 . 50 CEMENT General Shale Brick 0=0=00 Building The American Dream n:..:oice :.:.: :. . :::::::::::::::::::::::::::::::..::..: Invoice: 181884955 Invoice Date: 08/08/2013 Bill To: 279670 Customer PO: EMERSON CITY OF CARMEL 3400 W 131ST STREET Bill of Lading: 172093988 WESTFIELD IN 46074-8267 Goods Issue Date: 08/08/2013 Order: 316277473 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 6099000571 2 2 X 8 X 16 SOLID BLOCK 10 EA 0.75 7.50 Subtotal 7.50 TAX TOTAL 7.50 LATE PAYMENT CHARGE of 1.5s PER MONTH. 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)) 08/08/13 181884955 $7.50 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. ALLOWED 20 General Shale and Brick IN SUM OF $ P. O. Box 5825 Carol Stream, IL 60197-5825 $7.50 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 2201 I 181884955 I 42-362.001 $7.50 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 irk.y, August 23, 2013 &W;Q L Street Commissioner ssioner Title Cost distribution ledger classification if claim paid motor vehicle highway fund