223621 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367497 Page 1 of 1
ONE CIVIC SQUARE R S USED OIL SERVICES INC
` CARMEL, INDIANA 46032 25903 S RIDGELAND AVE CHECK AMOUNT: $410.36 1
`+ MONEE IL 60449
CHECK NUMBER: 223621
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350100 10616506 410 . 36 BUILDING REPAIRS & MA
!f® BINGE "'0 Invoice
oiceI
INTERNAL USE ONLY: 506-410-1-1 Page: 1 of 1
U B g I C rj
RS Used Oil Services, Inc Inarnat�on`
25903 S. Rid eland Avenue
g ... ... .. ..
Monee IL 60449 Invoice Number: 10616506
708 534 9300 Document Date: 08/08/2013
Order number: 100649016
Purchase Order No: 137761
Purchase Order Date: 08/08/2013
* * * PLEASE RETURN ONE COPY OF INVOICE WITH PAYMENT * * * Payment Terms: Net 30
Billing Date: 08/08/2013
Salesperson: JIM PURSEL
BrlIing Address 15360 Q00(Acct No): Invoice Amount: 410.36 USD
CARMEL STREET DEPT
3400 W 131 ST STREET
WESTFIELD IN 46074
Ship to; 15360 000 .
CARMEL STREET DEPT
Remit Payment To; 3400 W 131ST STREET
- - WESTFIELD IN 46074
RS Used Oil Services, Inc 317-733-2001
PO Box 310354
Des Moines IA 50331-0354
Shipping Instructions:
flltaterai `' Clyder.. tnvoiee : Unit : Amount.
.......................................................................................................................:.......................................................................::...:............................................................:>:
_...._..... ......_... _..........................._..................._..................................... ... ........... ....... ............ _........._.._._..
. .......... . ....... _ . __. .. ......... ........ _ _...... ._......._._. ._... ... .. ....
flescnptiion Qty E2ty Pncei
10000009075 422 EA 422 EA 0.38 160.36
LIQUID REMOVAL
10000009067 1 EA 1 EA 250.00 250.00
SERVICE FEE/HOUR
Tax 0.00
---------------
Total $ 410.36
A FINANCE CHARGE of 1 1/2%per month which is an ANNUAL PERCENTAGE RATE of 18%will be added to all accounts past due.
VOUCHER NO. WARRANT NO.
ALLOWED 20
RS Used Oil Services, Inc.
IN SUM OF $
25903 S. Ridgeland Avenue
Monee, IL 60449
$410.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I 10616506 I 43-501.001 $410.36 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
rid 2013
Wk.,VV W ———r�Tul L
Str(91WePGff4Ni@§Wher
Title
Cost distribution ledger classification if
claim paid motor 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 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 10616506 $410.36
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