226022 11/07/2013 \,f CITY OF CARMEL, INDIANA VENDOR: 358593 Page 1 of 1
ONE CIVIC SQUARE REPUBLIC WASTE SERVICES OF INDIA CHECK AMOUNT: $548.00
s�,? CARMEL, INDIANA 46032 PO BOX 9001099
LOUISVILLE KY 40290-1099 CHECK NUMBER: 226022
CHECK DATE: 11/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350101 REISSUE 548 . 00 0761-001733765
�R-A REPUBLIC CITY OF CARMEL BROOKSHIRE GOLF Invoice
44 SERVICES
Page 1 of 2
832 Langsdale Ave
Indianapolis,IN 46202-1150
Payments/Adjustments
• Date Description Reference Amount
08/05 Payment-Thank You 222560 -$572.86
MEW 08/23 Payment-Thank You 223173 -$608.00
Account Number 3-0761-0035460
Invoice Date August 31,2013 Current Invoice Charges
Invoice Number 0761-001733765 Brookshire Golf Course Ro/FI 12120 Brookshire Pkwy (L1) CSA 002765
Previous Balance $1,180.86 Carmel,IN
Payments/Adjustments -$1,180.86
Unpaid Balance $0.00 1 -Front Load(8 Yd) Scheduled Service (S1)
Current Invoice Charges $548.00 Date Description Reference Quantity Unit Price Amount
08/31 Basic Service 09101/13-09/30/13 $132.00 $132.00
Brookshire Golf Course Pt 12120 Brookshire Pkwy (1-2)
Carmel,IN
Q 2-Portable Unit Scheduled Service (S1)
_Uate Description Reference Quantity Unit Price Amount
Due By: 09120/13 08/05 Basic Service 2.0000 $30.00 $60.00
08/12 Basic Service 2.0000 $30.00 $60.00
o • e 08/19 Basic Service 2.0000 $30.00 $60.00
08/26 Basic Service 2.0000 $30.00 $60.00
Customer Service (317)917-7300 08/31 Portable Service 08/01/13-08/31/13 $176.00 $176.00
Current invoice Charges $548.00
• e o •
Effective 4/16/2012:SERVICE INTERRUPTION
POLICY CHANGE All accounts with a balance over
60 days will experience a service interruption unless
prior arrangements are made.
AYE"vif,r :Yyryf. .,.,,9Q*<i3AY9 ..34,,
548.00 0.00 0.00 0.00
To pay on-line or sign up for
convenient auto pay, go to: ; D A • Visit our website,www.disposal.com to make your payment electronically
www.disposal.com or to sign up for our convenient automatic payment plan.
• Please see reverse side for terms and conditions
CITY OF CARMEL BROOKSHIRE GOLF 3-0761-0035460 Page 2 of 2
Check Processing: In accordance with Federal Reserve Board guidelines, when you provide.a check as payment, you
authorize us to use information from your check to make a one-time electronic fund transfer from your account or to
process the payment as a check transaction. When we use information from your check to make an electronic fund
transfer, funds may be withdrawn from your account as soon as the same day we receive your payment and you will not
receive your check back from your financial institution. For further information visit: www.electronicpayments.org and click
on the Check Conversion tab.
If service is canceled during a billing cycle, the customer will remain responsible for all charges, fees and taxes through the
end of the billing cycle. There will be no proration of billing, and the customer will not be entitled to a refund for the period
between the notice of termination and the end of the current billing cycle. This provision will not apply if it is contrary to a
current franchise agreement, municipal contract, or other written contract applicable to this account or is otherwise
prohibited by law.
The Company reserves the right to require that payment for services be made only by check, credit card or money order,
unless otherwise required by contract or applicable law.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Republic Services#761
IN SUM OF $
P. O. Box 9001099
Louisville, KY 40290-1099
$548.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 1 0761-0017337651 43-501.01 1 $548.00 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
Friday, September 13, 2013
I
Director, Brooks re 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))
08/31/13 0761-001733765 Trash Removal $548.00
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