251699 11/18/15 ' ;� CITY OF CARMEL, INDIANA VENDOR: 00350983
® ; ONE CIVIC SQUARE R &T TIRE & AUTO - NOBLESVILLE CHECK AMOUNT: $"""`4,676.12'
i° CARMEL, INDIANA 46032 17016 CLOVER ROAD CHECK NUMBER: 251699
��TpN LQ` NOBLESVILLE IN 46060 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4232000 33218 N015KA 4,676.12 TIRES
R & T Tire-Noblesville R&T Frankfort(765)654-5588
R&T Lebanon(765)482-5027
R2
��/ 17016 Clover Rd R&T Sheridan(3 17) 758-4456
�' Noblesville, IN 46060 R&T Tipton(765)675-6775 1 L9T
317-773-3130
stn 1965
Store Location Store Phn Date Time
R & T Tire/Auto - NOB (317) 773-3130 10/30/15 11: 06 AM
17016 CLOVER RD file id: NOB-53866 Page 1
NOBLESVILLE, IN 46060
Your P/O A/R Acct Terms
Inv: N015KA JASON N05743 1 ST 10TH
Sold-To: Type - Payment
CARMEL POLICE DEPARTMENT $
3 CIVIC SQUARE $
CARMEL, IN 46032
Total $ 0.00
**MEMBER OF THE GOODYEAR TIRE & SERVICE NETWORK**" ARC 317-571-2546 GRAG W
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
8 GY732026500 245/55R18 103V GY EAGLE,RS-A4"!'. ' 127 .80 1022 .40 5
8 GY732354500 P225/60R16 97V S2 EAG�RS,;:A°<-.` BWL 89.00 712 .00 5
`:
8 GY732297500 235/55R17 EAG RS-A 98W S2 "VSB VSB109. 00 872 .00 5
8 GY732276500 P235/.5QR19 9'9W.'XL EAG AS-P. " 124 .00 992 .00 5
4 GY179748217 LT225/75R1"6 .115/1.1r2R" E`WRL" SR `" 125.97 503 .88 5
4 FS189820 "950-1- 5 TRANSFORCEtHT LRE `' 143 .46 573 .84 5
--------------------
V/Info:
s` ' t Sub-Total
g< $4676 .12
i
IN GOV'T, 0.00096
Total: $4676.12
NewPymt: $0.00
Total Due: $4676 . 12
Received By: SP: Chuck Godby
MINE_
City
(�° ������ INDIANA RETAIL TAX EXEMPT PAGE
®,Jlr CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT MM
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
I®i2"15
R&Y Tim and Auto Camol POIIco Depwtnaont
��ivi� �qu�
VENDO SHIP
�09� �i�vol'f ®�d TO Col, IN 4M
NOblosyllIG, IN 46M (W)I M-
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
p OUANT111 I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
`keen int 42-MCD
40 Each tires $110.92 $4.6711.72
Sulk Total: $4,070.72
%as � •
' Send Invoice To:
Camol P®lleo Dopadmont
Attn: Pat Young
3 CIVIC squaw
Domoi, IN 4 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT __AMOUNT
irmel Police Dept. �M,Uu.
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN '=
SHIP REPAID. THIS APP�TIOWSU FICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•
ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
X;^
SHIPPING LABELS. W of Pdliew
1•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
1 CLERK-TREASURER `
COPY-SIGN,AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO. —
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
20
Signature
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))
10/30/15 N015KA tires $4,676.12
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
R & T Tire and Auto
IN SUM OF $
17016 Clover Road
Noblesville, IN 46060
$4,676.12
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
33218 I N015KA I 42-320.00 I $4,676.12 I 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, November 13, 2015
! V
(Z/
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund