303518 09/26/16 *F CITY OF CARMEL, INDIANA VENDOR: 00350579
CHECK AMOUNT: $********22.00*
ONE CIVIC SQUARE R &T AUTO SUPPLY, INC
9 ,?a CARMEL, INDIANA 46032 516 S MAIN ST CHECK NUMBER: 303518
MUTON SHERIDAN IN 46069 CHECK DATE: 09/26/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 178387 22.00 TIRES & TUBES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
R &T AUTO SUPPLY, INC
516 S MAIN ST IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
SH ERI DAN, IN 46069 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$22.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
5802-148218 42-320.00 $22.00 1 hereby certify that the attached invoice(s),or 9/16/16 5802-148218 $22.00
2201 201 2201 201
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
Tuesday, September 20, 2016
Dave Huffman
Director
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
CaR UEST
ALI-ru 9ur•Ir-I_Y n INC, PAGE I
5'1 S MAIN STREET REF U 1.7 .338-1
AUTO PARTS SHERIDAN. a:rl 40106?
(317 ) 758---44S6
SERVING A WORI—D IN MOTION
5802--:14821_8 2070
ANY PART RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT. SEE CAROUEST STORE FOR DETAILS OF THIS COAST TO COAST GUARANTEE.
FLLJ�400
F Y l=11= L'�I'-1FR!"Ih l_. w1'I' Y OF C;�11tMEL.
W 1 1.Si T --9400 W 1 3_LS"f'
El{il'•1{ I._� .ilia 46074 o{jARMEL, IN 46074
. L MEAN',
5802-1.4821.6 2070 "l/1.6!201 I;RIA CHARGE
("(IS !)a:13r-'C1SAL_ 5 5 5>.00 un00 0.0015,.00 ter{
TIRE DISIPOSAI.-
11.19 DISPOSAL. 1 I 11 .67 7 ,.00 0.00 7 4 00 N/!
TIRE D11SPOSAL
WARRANTY DISCLAIMER:The manufacturers war it any,constitutes the only wart t e act to a ale of all goods.SELLER HE EXPRESSLY DISCLAIMS ALL RRANTIES,EITHER EXPRESSED OR IMPLIED,
INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PA U OSE. all r does not aut ze any Pe o grant any warranty or assume any Ilabllity,by Seller.
e �" I'e fes' ?I�'.# _ -
o.001 00 0.Q,!) 2 2.01
:.36.6 PAY TFIIS :::,C)I
. . ..CASH REFUND
Customer Name —
Customer Phone #t ( _)
Customer Mailing Address
Original Cash Sale Invoice ## _
Customers Si-nature
Couinterpro's Signature
Counterpro's # — -- --- —_ _
Manager's Initials
This is a company policy to lhelp verify- cash reftinds.and thc:s safeguard our assets.