252670 12/15/15 t CITY OF CARMEL, INDIANA VENDOR: 131135
® l ONE CIVIC SQUARE HOOSIER FIRE EQUIPMENT INC CHECK AMOUNT: $"''""3,410.00"
:.. ? CARMEL, INDIANA 46032 4009 MONTDALE PARK DRIVE CHECK NUMBER: 252670
VALPARAISO IN 46383 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 92066 3,410.00 AUTO REPAIR & MAINTEN
Page: 1
Invoice
Hoosier F i,'e Eq,Apment,Inc. Invoice Number: 0092066-IN
4009 MCAtdalF Park Drive Invoice Date: 12/8/2015
Valparaiso,Indiana 46383
(219)462-1707
Order Number:
Order Date
Salesperson: 0000 House
Customer Number: CARM01
Sold To: Ship To:
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel,IN 46032-7543 Carmel,IN 46032-7543
Confirm To:
I
Customer P.O. Ship VIA F.O.B. Terms i
PICK-UP DESTINATION Net 10
Item Code Unit Ordered Shipped Back Ordered Price Amount
/SERVICE EACH 1.00 1.00 0.00 3,410.00 3,410.00
PERFORMED SERVICE ON CUSTOMER'S 2010 SEAGRAVE TDA LADDER,SERIAL#76397
Net Invoice: 3,410.00
Less Discount: 0.00
Freight: 0.00
Sales Tax: 0.00
Invoice Total: 3,410.00
I
❑ HOOSIER FIRE EQUIPMENT, INC. ❑ HOOSIER FIRE EQUIPMENT, INC.
QTY. PART NO. AND/OR DESCRIPTION PRICE 4009 Montdale Park Drive 3863 North Commercial Parkway
2 Snap Ring $ 2.00 Valparaiso, IN 46383 Greenfield, IN 46140
2 Wear pad, Outer/Upper $ 143.00 Phone: 219-462-1707 Phone: 317-891-8375
29 Wear Pad $ 1,010.00 Toll Free: 800-552-2691 Toll Free: 888-436-6075
8 Nylatron Puck $ 453.00 REPAIR ORDER
2 Inner Horizontal Pin $ 47.00 NAME: Carmel Fire Department RECEIVED: 11/30/2015 DATE: 12/8/2015
CUSTOMER
2 Bushing $ 58.00 ADDRESS Two Civic Square PROMISEDORDER# ST2010
1 Shipping/Freight $ 34.00 CITY: Carmel, Indiana 46032 TERMS: MECHANIC: MS
PHONE: Bob Van Voorst Cell 317-664-0958
MAKE' MODEL: YR. SERIAL NO. UNIT MILEAGE AR 4
Seagrave TDA Ladder 1 2010 1 76397 Ladder 41 36,856 7878
LABOR REPAIR ORDER INSTRUCTIONS LABOR
HOURS CHARGE
Fire Department advised outriggers binding&have lost wear pads.
Disassembled &completely removed left outrigger&jack. Assess damage,
cleaned parts&ordered necessary new parts.
Assembled removed outrigger& installed same in truck. Installed wear pads.
Finished installing wear pads, installed sheet metal body parts, drift tested
outriggers and jacks.
All cylinders lost< 1/8" in one hour. All cylinders passed drift test.
$ 1,663.00
ADDITIONAL PARTS SEE LIST ON BACK
PARTS TOTAL $ 1,747.00
SUBLET WORK PRICE
I hereby authorize the above repair work to be done w/the necessary material,and hereby grant you and/or your employees
permission to operate the car or truck herein described on streets,highways or elsewhere for the purpose of testing
and/or Inspection. An express mechanic's lien is hereby acknowledged on above car or truck to secure the amt.of repairs thereto.
X TOTAL LABOR: $ 1,663.00
TOTAL PARTS: $ 1,747.00
NOT RESPONSIBLE
FORLOSSOR MILES TRAVEL RATE PRICE SUBLET WORK:
DAMAGE TO CARS OR
ARTICLES LEFT IN TRAVEL EXP.
CARS IN CASE OF
FIRE,THEFT OR ANY TAX:
OTHER CAUSE
BEYOND OUR
SUBLET WORK TOTAL CONTROL. TOTAL TRAVEL EXPENSES: TOTAL =N11 $ 3,410.00
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))
92066 $3,410.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hoosier Fire Equipment
IN SUM OF $
4009 Montdale Park Drive
Valparaiso, IN 46383
$3,410.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 92066 43-510.00 $3,410.00 1 hereby certify that the attached invoice(s), or
1120 43-510.00 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
DEC 1 4 2015
MAOi
. .
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund