244676 04/29/15 CITY OF CARMEL, INDIANA VENDOR: 369300
ONE CIVIC SQUARE CLARK POWER SERVICES INC CHECK AMOUNT: $*******720.51*
;9q CARMEL, INDIANA 46032 PO BOX 710157 CHECK NUMBER: 244676
CINCINNATI OH 45271-0157 CHECK DATE: 04/29/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 S107018545 720.51 AUTO REPAIR & MAINTEN
1240 W.THOMPSON ROAD
.., CLARKEINDIANAPOLIS,IN 46217 1
we Phone:(317)783-6651 Fax:(317)786-3787
POWER SERVICES,INC.
SERVICE ORDER: 5107018545
LINQ: 1267450
BILLTO DELIVER TO
City Of Carmel-129371 City Of Carmel-129371
9609 HAZEL DELL PKWY 9609 HAZEL DELL PKWY
INDIANAPOLIS IN46280 INDIANAPOLIS IN46280
P:(317)733-2001 P:(317)691-6725
DATE PROMISED DATE INVOICE SALES TYPE ADVISOR TERMS CUSTOMER REFERENCE
2/28/2015 2:30:OOPM Sc Ryan C CASH
YEAR MAKE MODEL VIN CUSTOMER UNIT# COMPONENT S/N IN SERVICE ODOMETER IN ODOMETER OUT
2005 GMC C8500 1GDTSC4C45F512971 204 47917 47917
JOB 91 045-000-000 SC Power Plant
COMPLAINT SHIFTS HARD OUT OF FIRST GEAR,UP AND DOWN SHIFTING IN 3RD AND 4TH GEARS
CAUSE
CORRECTION BROUGHT INTO THE SHOP AND COULD NOT COMMUNICATE WITH DOC.STARTED TROUBLESHOOTING THE
71708 DATABUS.HOOKED UP TO THE TCM WITH OUR REFLASH HARNESS.FOUND OUTPUT SPEED SENSOR
FAULTS.FOUND THE OSS TWISTED PAIR SHORTED TO THE TRANS HOUSING.REPLACED THE WIRING TO THE
OUT PUT SPEED SENSOR.WENT ON TEST DRIVE AND IT WORKS.
QTY I ITEM VMRS DESCRIPTION I UNIT PRICE I EXTD PRICE
LABOR TRKZZZ TRUCK REPAIR-MISC GENERAL LABO 658.00
TOTAL JOB#1 045-000-000 658.00
li
PRS FORMA INVOICE
Customer authorizes Clarke Power Services,Inc.("Clarke")to perform the above work and SUBTOTAL 658.00
to furnish all necessary parts and materials. Customer agrees to the Terms and Conditions
Ir Service of Vehicles posted on Clarke's website, SHOP SUPPLIES 46.06
PLEASE NOTE www.clarkepowerservices.com/tennsconditions,and understands they are incorporated EPA CHARGE 16.45
herein by reference and also available to Customer from Clarke upon request SALES TAX 4.38
TOTAL I 724.89
AUTHORIZED BY DATE
Please Remit Payment to:
PICK-UP BY DATE CLARKE POWER SERVICES,INC.
PO Box 710157
Cincinnati,OH!45271-0157
CONTACT CUST DATE/TIME Phone:(513)771-2200
Fax:(513)771-0520
Page 1 of 1
Form ST-105 Indiana Department of Revenue
State Form 49065 R4/8-05 General Sales Tax Exemption Certificate
Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana
code. Exemption statutes of other states are not valid for purchases from Indiana vendors.This exemption certificate can not be issued for the
purchase of Utilities, Vehicles Watercra ,or Aircraft, Purchaser must be registered with the Department of Revenue or the appropriate taxing
authority of the purchaser's state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser.Purchasers not able to provide all required
information must pay the tax and may file a claim for refund(Form GA-110L)directly with the Department of Revenue.
Name of Purchaser CITY OF CARMEL
Business Address ONE CIVIC SQUARE City CARMEL State IN Zip 46032
Fes;
Purchaser must provide minimum of one ID number below.*
Provide your Indiana Registered Retail Merchant's Certificate
TID and LOC Number as shown on your Certificate...............................
0031201550 — 020
TID#(10 digits) LOC#(3 digits)
If not registered with the Indiana DOR,provide your State Tax
ID Number from another State...................................................
. .............
*See instructions on the reverse side if you do not have either number. State ID# State of Issue
Is this a ®blanket purchase exemption request or a ❑single purchase exemption request? (check one)
� Description of items to be purchased.
Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain)
❑ Sales to a retailer,wholesaler,or manufacturer for resale only.
❑ Sale of manufacturing machinery,tools,and equipment to be used directly in direct production.
❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10.
(May not be used for personal hotel rooms and meals.)
❑ Sales of tangible personal property predominately used(greater then 50 percent)in providing public transportation-provide USDOT#.
A person or corporation who is hauling under someone else's motor carrier authority,or has a contract as a school bus operator,must
.y provide their SS#or FID#in lieu of a State ID#in Section#1. USDOT#
❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agricultural products for sale.
Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a State ID#in Section#1.
❑ Sales to a contractor for exempt projects(such as public schools,government,or nonprofits).
Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and state universities).
D Sales to the United States Federal Government-show agency name.
Note:A U.S.Government agency should enter its Federal Identification Number(FID#)in Section#1 in lieu of a State ID#.
❑ Other-explain.
I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt
purpose pursuant to the State Gross Retail Sales Tax Act,Indiana Code 6-2.5,and the item purchased is not a utility,vehicle,watercraft,or aircraft.
I confirm my understanding that misuse either negligen r' entionao,and/or fraudulent use of this certificate may subject both me personally
and/or the business entity I represent a irtii5osition ter and civil and/or criminal penalties.
Signature of Purchaser Date 41a t I l
Printed Name DIANA L CORDRAY Title CLERK-TREAURER
The Indiana Department of Revenue may request verification o registration in another state if you are an out-of-state purchaser.
Seller must keep this certificate on file to support exempt sales.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clarke Power Services, Inc.
IN SUM OF$
r
PO Box 710157
Cincinnati, OH 45271-0157 !
$720.51
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department !�
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I S107018545 I 43-510.001 $720.51 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
T usda ril 23, 2015
mP_f`ommlissllin
icin
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))
02/28/15 S107018545 $720.51
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
120
Clerk-Treasurer