225486 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 366089 Page 1 of 1
ONE CIVIC SQUARE NORTH CENTRAL CO-OP CHECK AMOUNT: $3,210.21
�t? CARMEL, INDIANA 46032 Po Box 299
WABASH IN 46992 CHECK NUMBER: 225486
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4231300 GT403774 1, 421 . 00 DIESEL FUEL
1207 4231400 GT403774 1, 092 . 71 GASOLINE
2201 4231300 GT403841 696 . 50 DIESEL FUEL
NOMEWarsaw Wabash Peru Goshen Angola Fremont Logansport Plymouth Rochester
Cw?mmKokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
Co-op Branch Co. MI Hart MI Noble I 877/13 16:29
4792 DATE 10/04/13 16:89:13
517-278-4561 231-873-2158 765-67IC $ START 0.0 END 338.3
P.O.BOX 299 800-440-2667
WABASH,IN 46992 317-77 36 DELIVERY 338.3 GALLONS
4011 87 E-10 PLUS GASOLINE 1
** MULTIPLE DELIVERIES AT SITE **
SALE 8904 DATE 10/04/13 16:18:11
COUNT: START 0,0 END 406.0
GROSS DELIVERY 406.0 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
*e MULTIPLE DELIVERIES AT SITE
CHARGE INVOICE
Driver: GT GARY TEETERS
Customer: 0000918936 Invoice #: 6T 403774
BROOKSHIRE GOLF CLUB Date: 10/4/2013
CITY OF CARMEL Tice: 16:01
12120 BROOKSHIRE PKWY
CARMEL, IN 46033—
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4011 87 E-10 PLUS E 338.3000 3.05000 1031.82
State Road Tax 0.18000 60.89
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 406.0000 3.50000 1421.00
Legend: Invoice Subtotal: 2,513.71
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 2,513.71
WARNING — PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-424-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
O
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P.O. Box 299
Wabash, IN 46992
$2,513.71
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 GT 403774 42-314.00 $1,092.71 1 hereby certify that the attached invoice(s), or
1207 GT 403774 42-313.00 $1,421.00 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
Tuesday, October 15, 2013
Director, Brookshir Golf Club
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))
10/04/13 I GT 403774 I Fuel I $1,092.71
10/04/13 I GT403774 I Fuel I $1,421.00
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
, 20
Clerk-Treasurer
NORMWarsaw Wabash Peru Goshen Angola Fremont Logansport PI mouth Rochester
g Y
(CHM%U Kokomo Huntington Auburn Constantine 574-753-3673 Star City
Call: 800-720-0550 Call: 800-234-0573 800-807-3673 Call: 574-224-2667
Branch Co.
877-615-2667
517 278-45611 231-873-2158 1 765o67�Vi238
8951 DATE 10/11/13 15:59:05
P.O. BOX 299 800-440-2667 317-7730 START 0.0 END 199.0
WABASH, IN 46992 GROSS DELIVERY 199.0 GALLONS
4040 SUPER DX-4 BIODIESDISTILLATI
*# MULTIPLE DELIVERIES AT SITE *
CHARGE INVOICE
Driver: OT GARY TEETERS
Customer: 0000921720 Invoice #: GT 403841
CARMEL STREET DEPT Date: 10/11/2013
33400 W 131ST STREET Time: 15:37
CARMEL, IN 46074
Tres Terms Description Item # Description Legend Quantity Unit Price Item Total
02 NORMAL CHARGE TERMS 4040 SUPER DX-4 BIODIESEL E 199.0000 3.50000 696.50
Legend: Invoice Subtotal: 696.50
E=Metered, T=Taxable, *=Entered by Hand Indiana Sales Tax On: 0.00 ..... 0.00
Invoice Total: 696.50
WARNING - PETROLEUM PRODUCTS NOT TO BE USED FOR STARTING OR KINDLING FIRES. GASOLINES NOT SOLD FOR
ILLUMINATING OR CLEANING PURPOSES. IN CASE OF EMERGENCY CONTACT CHEMTREC AT 1-800-4224-9300 WE
APPRECIATE YOUR BUSINESS!!!
Customer Signature:
CU
O ST
VOUCHER NO. WARRANT NO.
ALLOWED 20
North Central Co-op
IN SUM OF $
P. O.. Box 299
Wabash, IN 46992
$696.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
2201 I GT 403841 I 42-313.001 $696.50 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
J/Wedn ay, 013
S�eeief:0cmrrQiasi�inaer
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))
10/11/13 GT 403841 $696.50
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