226969 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 092000 Page 1 of 1
ONE CIVIC SQUARE FASTENAL COMPANY CHECK AMOUNT: $15.34
'�to CARMEL, INDIANA 46032 PO BOX 1286
•y, o��; WINONAMN 55987-1286 CHECK NUMBER: 226969
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 ININ2164117 15 . 34 REPAIR PARTS
® ® Remit to INVOICE
)1LS7EANL Fastenal Company
P.O. Box 1286 Page 1 of 1
Winona, MN 55987-1286
Date Invoice No.
Cust. No. ININ20009 For billing questions 11/25/2013 ININ2164117
Cust. P.O. Hanover 14775 Herriman Blvd
Job No. NOBLESVILLE, IN 46060 Due Date Invoice Total
Contract No. QPA# 11179 Phone (317)770-0649 12/25/2013 15.34 USD
Sold To Fax (317)770-4279
000547001 AB 0.381 "AUTO H6 1 1070 46074-8-05470
'II111111111"I'111111'1111"11'11"111111111111"IIII'I'111'II'I Ship To
CARMEL STREET DEPT. Picked up at branch
3400 W 131 ST ST 14775 Herriman Blvd
CARMEL, IN 46074-8267 NOBLESVILLE, IN 46060
This Order and Document is subject to the "Terms of Purchase" posted on www.fastenal.com.
Line Quantity Quantity Quantity Control Part Price/
No Ordered Shipped Backordered Description No. No. Hundred Amount
1 2 2 0 #25 TORX SECURITYBIT 220012299 Y665500000OH40 189.4200 3.79 T Y
0
2 1 1 0 BIT#2 1/4X3 1/2 PH 136728 61309 46.0000 0.46 T Y
3 1 1 0 3/8"X 4"Nuset INSTYY 0208963 305.6900 3.06 T Y
4 3 3 0 7/32 B&G w1135SP DB TOPEST 0345847 147.3700 4.42 T Y
5 1 1 0 ULTRA LUBE 4 OZ. NORSEM 0301864 261.2800 2.61 T Y
Received By Tax Exemption Subtotal 14.34
Shipping&Handling 0.00
Comments IN State Tax 1.00
County Tax 0.00
Contact:Ralph City Tax 0.00
Total 15.34
Reasonable collection and attorneys fees will be No materials accepted for return without our permission.
assessed to all accounts placed for collection. All discrepancies must be reported within 10 days.
If you re-package or re-sell this product, you are required to maintain Please pay from this invoice.
integrity of Country of Origin to the consumer of this product.
0005470-01.0016969 Invoice: ININ2164117 Cust: ININ20009
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fastenal
IN SUM OF $
P. O. Box 1286
Winona, MN 55987-0978
$15.34
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
2201 I ININ2164117 I 42-370.001 $15.34 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
° Frid y De er 06, 2013
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))
11/25/13 I N I N2164117 $15.34
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