241361 1 /22/2015 CITY OF CARMEL, INDIANA VENDOR: 366480
® ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $ ..."'180.50'
s r4 CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT CHECK NUMBER: 241361
•�, oN e� PD Box 1630 CHECK DATE: 01/22/15
GREEN BAY WI 54305-1630
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 910025826 180.50 OTHER EXPENSES
SHPN577488261
POMP'S TIRE-LAFAYETTE INVOICE #: 910025826
2700 SCHUYLER AVE
PAGE: 1
LAFAYETTE, IN 47905
765/742-4000
CUSTOMER: CITY OF CARMEL WATER OPER SHIP TO: DELIVERED VIA S. RUMMEL
3450 W 131ST STREET
2266
CARMEL, IN
46074
CREATED BY DBL
FAX NUMBER: 3177332053
WORK: 317/733-2855 0
SALESMAN: MICHAEL S RUMMEL
INVOICE DATE: 01/09/15 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
-------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
P225/60TR16 H727 2 90.00 180.00
10OH6121
TIRE USER FEE - IN 2 .25 0. 50
950L13
Registration: Serial# T7BMDMH3213 Quantity 2
MERCHANDISE: 180.00
OTHER: 0. 50
INVOICE TOTAL: 180. 50
ON ACCOUNT A/R 180. 50
**A COPY OF THIS INVOICE HAS BEEN EMAILED'
Printed Name signature
LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES.
Page 1
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
366480
Pomp's Tire Purchase Order No.
PO BOX 1630 Terms
GREEN BAY, WI 54305-1630 Due Date 1/13/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/13/2015 910025826 $180.50
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and II have audited same in accordance with IC 5-11-10-1.6
Date Officer
}
VOUCHER # 142749 WARRANT # ALLOWED
366480 IN SUM OF $
Pomp's Tire
PO BOX 1630
GREEN BAY, WI 54305-1630
Carmel Water Utility f
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
910025826 01-6500-05 $180.50
i
I
Voucher Total $180.50 I.
Cost distribution ledger classification if
claim paid under vehicle highway fund