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Home My WebLink About304733 10/31/16 +yt,Cgg3 CITY OF CARMEL, INDIANA VENDOR: 370797 ONE CIVIC SQUARE POMP'S TIRE-LEBANON CHECK AMOUNT: $*****5,922.72* CARMEL, INDIANA 46032 1316 W SOUTH STREET CHECK NUMBER: 304733 LEBANON IN 46052 CHECK DATE: 10/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 830072396 414.36 OTHER EXPENSES 1120 4351000 830072485 1,765.64 AUTO REPAIR & MAINTEN 601 5023990 830072690 460.00 OTHER EXPENSES 601 5023990 830072692 465.00 OTHER EXPENSES 2201 4232000 830072854 2,765.16 TIRES & TUBES 2201 4232000 830073030 52.56 TIRES & TUBES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) POMP'S TIRE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER ATTN: AR DEPARTMENT IN SUM OF$ CITY OF CARMEL PO BOX 1630 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service GREEN BAY, WI 54305-1630 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $1,765.64 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire 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 830072485 43-510.00 $1,765.64 1 hereby certify that the attached invoice(s),or 10/24/16 830072485 E340 $1,765.64 1120 101 1120 101 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 Monday, October 24,2016 David Haboush Fire Chief s 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer SHPN577185878 POMP'S TIRE-LEBANON INVOICE #: 830072485 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL FIRE DEPT 2 CIVIC SQUARE 2009963 FIRE HEADQUARTERS CARMEL, IN 46032 CREATED BY JM REF NUMBER: DR1502034 FAX NUMBER: 317-571-2615 BUSINESS: 317/571-2600 0 SALESMAN: SHANE RUMMEL INVOICE DATE: 10/13/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV ------------------------------------------------------------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------------------------------------------------------------------------------- 12R22.5/16 F/S T-663 4 391.16 1564.64 151F009 TIRE USER FEE - IN 4 .25 1.00 950L13 CORRECTED TO CURRENT STATE OF IN 7130 CONTRACT PRICING ROAD SERVICE - REGULAR 8333 2.00 85.00 170.00 RS TO STATION CARMEL, IN STANDARD BRASS TRUCK VALVE 4 7.50 30.00 TVALV CM#6452158500 D]S MERCHANDISE: 1594.64 LABOR: 170.00 OTHER: 1.00 OFFICE COPY INVOICE TOTAL: 1765.64 GOVERNMENT 1765.64 °*A COPY OF THIS INVOICE HAS BEEN EMAILED"* THANK YOU FOR YOUR BUSINESS M ! Printed Name Signature . LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 VOUCHER# 162990 WARRANT# ALLOWED 366480 IN SUM OF $ Pomp's Tire PO BOX 1630 GREEN BAY, WI 54305-1630 9 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 830072692 01-6500-04 465.00 Voucher Total 465.00 Cost distribution ledger classification if claim paid under 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 of service rendered, by whom, rates per day, number of units, t price per unit, etc. Payee 366480 Pomp's Tire Purchase Order No. PO BOX 1630 Terms GREEN BAY, WI 54305-1630 Due Date 10/10/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/10/201( 830072692 465.00 hereby certify that the attached invoice(s), or bill(s) is(are)true and orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Officer SHPN577179204.TXT POMP'S TIRE-LEBANON INVOICE #: 830072692 1316 WEST SOUTH STREET LEBANON, IN 46052 PAGE: 1 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 W 131ST STREET 2266 CARMEL, IN 46074 CREATED BY JM REF NUMBER: DRHGS137570 FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL INVOICE DATE: 10/10/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV ------------------------------------------------------------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------------------------------------------------------------------------------- P235/70TR17/XL HANKOOK RH12 BL 4 116.00 464.00 101H2468 TIRE USER FEE - IN 4 .25 1.00 95OL13 Registration: serial NA Quantity 4 00 DJS MERCHANDISE: 464.00 OTHER: 1.00 OFFICE COPY INVOICE TOTAL: 465.00 GOVERNMENT 465.00 ***A COPY OF THIS INVOICE HAS BEEN EMAILED** THANK YOU FOR YOUR BUSINESS! ! ! ! Printed Name Signature . LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 TTANCE ADDRES: 1 P POMP'S-TIRE SERVICE, INC. POMP!STIRE SERVICE,SNC. ATTN: AR DEPARTMENT +� P.O. BOX 1630 --/f<�E SERVICE GREEN BAY, WI 54305-1630 POMP'S TIRE—LEBANON WORK ORDER #: 830072692 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 W 131ST STREET 2266 CARMEL, IN 46074 CREATED BY JM FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL WRK ORD DATE: 10/04/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV PRODUCT MECHANIC QUANTITY PRICE_. F.E.T.. EXTENSION, P235/70TR17/XL HANKOOK RH12 BL 4 116.00 464.00 1O1H2468 TIRE USER FEE — IN 4 .25 1.00 950L13 Registration: Serial Quantity 1 MERCHANDISE: 464.00 OTHER: 1.00 WORK ORDER TOTAL: 465.00 THANK YOU FOR YOUR BUSINESS! ! ! ! A finance charge of 1,5%per month 18%APR will be added to the unpaid balance after 30 days CUSTOMER ESTIMATE SELECTION I hereby authorize the below repair work to be done along with necessary materials.You and your employees may operate You are entitled to a price estimate for the repairs you have authorized.The repair price may be less than the estimate but vehicle for purposes of testing,inspection or delivery at my risk.An express mechanic's lien is acknowledged on vehicle to will not exceed the estimate without your permission.Your signature will indicate your estimate selection. secure the amount of repairs thereto.You will not be held responsible for loss or damage to vehicle or articles left in vehicle 1.1 request an estimate in writing before you begin repairs. in case of fire,theft,accident,damage from freezing due to lack of antifreeze or any other causes beyond your control. 2.Please proceed with repairs but call me before continuing if price will exceed S_ CUSTOMER SIGNATURE 3.1 do not want an estimate. ADDITIONAL WORK AUTHORIZED BY;_____._ Do you want the replaced parts you are entitled lo?I 11' EST 6UITED PRICE OF REPAIRS LYES I IND A.M. ' � — Name VOUCHER # 163107 WARRANT# ALLOWED 366480 IN SUM OF $ Pomp's Tire PO BOX 1630 GREEN BAY, WI 54305-1630 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 830072690 01-6500-04 460.00 Voucher Total 460.00 Cost distribution ledger classification if claim paid under 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 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 10/24/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/24/201( 830072690 460.00 hereby certify that the attached invoice(s), or bill(s) is (are)true and -orrect and I have audited same in accordance with IC 5-11-10-1.6 Date . Officer SHPN577190976.TXT POMP'S TIRE-LEBANON INVOICE #: 830072690 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 w 131ST STREET 2266 CARMEL, IN 46074 REF NUMBER: DR1504440 FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL INVOICE DATE: 10/18/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV ------------------------------------------------------------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------------------------------------------------------------------------------- P235/70SR16 DEST A/T OWL 4 114.75 459.00 026F767 TIRE USER FEE - IN 4 .25 1.00 950L13 Registration: Serial WB08DA22915 Quantity 3 Registration: Serial WB08DA23116 Quantity 1 BSCM# 6452362308 Pv GOV CONTR 7130 MERCHANDISE: 459.00 OTHER: 1.00 OFFICE COPY INVOICE TOTAL: 460.00 GOVERNMENT 460.00 ***A COPY OF THIS INVOICE HAS BEEN EMAILED** THANK YOU FOR YOUR BUSINESS! ! ! ! Printed Name signature LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 REM TTANCE ADDRES: ' m POMP'S TIRE SERVICE, INC. POMP!S TIRE S RVICESINC. ■ ■ ■ ATTN: AR DEPARTMENT P.O. BOX 1630 _= m/fIRE:S6RUlCE.w^ = GREEN BAY, WI 54305-1630 POMP'S TIRE—LEBANON WORK ORDER #: 830072690 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 W 131ST STREET 2266 CARMEL, IN 46074 FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL WRK ORD DATE: 10/04/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION P235/70SR16 DEST A/T OWL 4 116.00 464 .00 . 026F767 TIRE USER FEE — IN 4 .25 1.00 950L13 Registration: Serial Quantity 1 MERCHANDISE: 464.00 OTHER: 1.00 WORK ORDER TOTAL: 465.00 THANK YOU FOR YOUR BUSINESS! ! ! ! A finance charge of 1.5%per month 18%APR will be added to the unpaid balance after 30 days. CUSTOMER ESTIMATE SELECTION I hereby authorize the below repair work to be done along with necessary materials.You and your employees may operate You are entitled to a price estimate for the repairs you have authorized.The repair price maybe less than the estimate but vehicle for purposes of testing,inspection or delivery at my risk.An express mechanic's lien is acknowledged on vehicle to will not exceed the estimate without your permission.Your signature will indicate your estimate selection. secure the amount of repairs thereto.You will not be held responsible for loss or damage to vehicle or articles left in vehicle 1.1 request an estimate in writing before you begin repairs, _ __ in case of fire,theft,accident,damage from freezing due to lack of antifreeze or any other causes beyond your control. 2.Please proceed with repairs but call me before continuing CUSTOMERS I GNAT URE X�, =f if price will exceed S_ -- 1.1 do not want an estimate. ADDITIONAL WORK AUTHORIZED BY:...---.. I""` ESTIh1ATED PRICE OF REPAIRS _......_......._.�...... ___.___..�_..�____.....__ nn vnu want the renlared narls mu are entitled 107( IYFS I NO a r( Name VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) POMPS TIRE-LAFAYETTE ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 2700 SCHUYLER AVENUE IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service LAFAYETTE, IN 46905 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $2,817.72 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 830072854 42-320.00 $2,765.16 1 hereby certify that the attached invoice(s),or 10/6/16 830072854 $2,765.16 2201 201 2201 201 830073030 42-320.00 $52.56 bill(s)is(are)true and correct and that the 10/10/16 830073030 $52.56 2201 201 materials or services itemized thereon for 2201 1 201 which charge is made were ordered and received except Tuesday, October 11,2016 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer SHPN577176048.TXT POMP'S TIRE-LEBANON INVOICE #: 830072854 1316 WEST SOUTH STREET LEBANON, IN 46052 PAGE: 1 765/482-4359 i CUSTOMER: CITY OF CARMEL STREET DEP 2264 3400 W 131ST STREET CARMEL, IN 46074 CREATED BY JRM FAX NUMBER: 3177332005 BUSINESS: 317/733-2001 0 PO NUMBER: BENTLEY SALESMAN: SHANE RUMMEL INVOICE DATE: TERMS: PMT DUE 10TH OF MON AFTR INV- - _--- ----------------- _---------------- ------'-------- PRODUCTMECHANIC QUANTITY PRICE F.E.T. EXTENSION----------------------------- -- --------------------------------- 17.5L24/10 AT UTILITY TL R-4 2 483.21 966.42 325F880 TIRE USER FEE - IN 2 .25 0.50 950L13 18.4-30/8 F/S SAT II TL 2 728.87 1457.74 372F626 TIRE USER FEE - IN 2 .25 0.50 950L13 ROAD SERVICE - REGULAR 8333 4.00 85.00 RS 340.00 REPLACE TIRES MERCHANDISE: 2424.16 LABOR: , 340.00 OFFICE COPY OTHER: 1.00 INVOICE TOTAL: 2765.16 ON ACCOUNT A/R 2765.16 ***A COPY OF THIS INVOICE HAS BEEN EMAILED** THANK YOU FOR YOUR. BUSINESS! ! ! ! Printed Name Signature LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 SHPN577180532.TXT POMP'S TIRE-LEBANON INVOICE #: 830073030 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL STREET DEP 3400 W 131ST STREET 2264 CARMEL, IN 46074 CREATED BY JRM FAX NUMBER: 3177332005 BUSINESS: 317/733-2001 0 SALESMAN: SHANE RUMMEL INVOICE DATE: 10/10/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV ------------------------------------------------------------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------------------------------------------------------------------------------- 15X8 GKN WHEEL 6-6-4.62 -1 53.44 -53.44 W50334P10 15X7 6 ON 6 LUG KABOTA WHEEL 1 106.00 106.00 MISWHESTK CORRECTION FROM INVOICE#830071903 MERCHANDISE: 52.56 OFFICE COPY INVOICE TOTAL: 52.56 ON ACCOUNT A/R 52.56 ***A COPY OF THIS INVOICE HAS BEEN. EMAILED** THANK YOU FOR YOUR BUSINESS M ! Printed Name signature LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 INC. REMITTANCE ADDRESS: POMP'S TIRE SERVICE, NPOMP'S TIRE SERVICE,INC. P J ATTN:AR DEPARTMENT 'P.O.BOX 1630. r11 E=a iEl VICEIRMI, GREEN BAY,WI 54305-1630 POMP ' S .TIRE-LEBANON INVOICE #: 830073030 - 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 7.65/482-4359 CUSTOMER: " CITY OF CARMEL -STREET -DEP., 3400 W. 131ST STREET 2264 CARMEL, IN: 46074 CREATED BY JRM FAX NUMBER: 3177332005 BUSINESS : 317/733-2001 0 . SALESMAN: SHANE RUMMEL INVOICE DATE: 10/10/16 TERMS : . 1 PMT DUE 10TH OF MON• AFTR INV --------------------------- , PRODUCT MECHANIC QUANTITY PRICE F.E .T. EXTENSION. -------------------------------------------------------------------- 15X8 GKN WHEEL 6-8-4 . 62. -1 53 . 44 -53 . 44 W50334P10 15X7 6-ON 6 -LUG KABOTA WHEEL 1 106 . 00. 106 . 00 MISWHESTKK CORRECTION; FROM INVOICE48300,71903 Emailed- to alunn@carmel . in.gov on 10/10/16 at 14 : 36 : 08 . Document type: SHPN MERCHANDISE: 52 . 56 CUSTOMER COPY INVOICE TOTAL:; ` :_ 52 . 56 ON ACCOUNT A/R 52 . 56 THANK YOU. FOR YOUR BUSINESS ! ! ! ! Printed Name Signature LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES . POMP ';S TIRE-LEBANON ESTIMATE : 85500 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL STREET DEP 3400 W 131ST STREET 2.264 CARMEL, IN 46074 CREATED BY JRM FAX NUMBER: 3177332005 BUSINESS : 317/733-2001 0 SALESMAN: SHANE RUMMEL ESTIMATE DATE: 09/19/16 TERMS : 1 PMT DUE 10TH OF MON AFTR INV --- --------------------------- ------ --------=--------- ------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------ ---------------- - --- - -- - -- ---- -- - ------- ----- - -- ------------------------- 17 . 5L24/10 AT UTILITY TL R-4 2 483 . 21 966 . 42 325F880 TIRE USER FEE - IN 2 . 25 0 . 50 950L13 18.. 4-30/8 FIS SAT II TL 2 728 .87 14.57 . 74 372F626 TIRE USER FEE - IN 2 .25 0 . 50 950L13 ROAD SERVICE - REGULAR 4 . 00 85 . 00 340 . 00 RS MERCHANDISE: 2424 . 16 LABOR: 340 .00 OTHER: 1 . 00 ESTIMATE TOTAL: 2765 . 16 THANK YOU FOR YOUR BUSINESS ! ! ! ! ***** Valid for 30 days ***** VOUCHER# 163013 WARRANT# ALLOWED 366480 IN SUM OF $ Pomp's Tire PO BOX_ 1630 GREEN BAY, WI 54305-1630 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code ,9�90k896'4�`01`650@=0 -Xb-t x-56 Le (o5b-tt QILI-3� . Cf Voucher Total -- , Cost distribution ledger classification if claim paid under 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 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 10/17/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 10/17/201( 910048964 88.00 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 Date Officer � M SHPN577187687.TXT POMP'S TIRE-LEBANON INVOICE #: 830072396 1316 WEST SOUTH STREET LEBANON, IN 46052 PAGE: 1 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 w 131ST STREET 2266 CARMEL, IN 46074 CREATED BY JRM REF NUMBER: DR1502033 FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL INVOICE DATE: 10/14/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV -----------------------------.-------------------------------------------------- PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION ------------------------------------------------------------------------------- P235/70TR16 DEST LE2 WL XL 4 103.34 413.36 097F759 TIRE USER FEE - IN 4 .25 1.00 950L13 Registration: Serial 8X08DE12716 Quantity 2 Registration: Serial 8X08DE12216 Quantity 2 CUSTOMER CARRY OUT BSCM# 6452158504 PV MERCHANDISE: 413.36 OTHER: 1.00 OFFICE COPY INVOICE TOTAL: 414.36 GOVERNMENT 414.36 ***A COPY OF THIS INVOICE HAS BEEN EMAILED** THANK YOU FOR YOUR BUSINESS M ! Printed Name Signature LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. Page 1 ,1 POMP'S TI SERVICE INC. REMITTANCE ADDRESS: P11 .� POMP'S TIRE SERVICE, INC. ` ATTN: AR DEPARTMENT .r* P.O. BOX 1630 1RE:�FRU1�6 k'=' GREEN BAY, WI 54305-1630 POMP'S TIRE-LEBANON WORK ORDER #: 830072396 1316 WEST SOUTH STREET PAGE: 1 LEBANON, IN 46052 765/482-4359 CUSTOMER: CITY OF CARMEL WATER OPER 3450 W 131ST STREET 2266 CARMEL, IN 46074 CREATED BY JRM FAX NUMBER: 3177332053 BUSINESS: 317/733-2855 0 SALESMAN: SHANE RUMMEL WRK ORD DATE: 09/28/16 TERMS: 1 PMT DUE 10TH OF MON AFTR INV PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION P235/70TR16 DEST LE2 WL XL 4 103 .34 413 .36 097F759 TIRE USER FEE - IN 4 .25 1.00 950L13 Registration: Serial 8XO8DE12716 Quantity 2 Registration: Serial 8XO8DE12216 Quantity 2 CUSTOMER CARRY OUT MERCHANDISE: 413.36 OTHER: 1.00 WORK ORDER TOTAL: 414.36 THANK YOU FOR YOUR BUSINESS! ! ! ! C� A finance charge of 1.5%per month 18%APR will be added to the unpaid balance after 30 days. CUSTOMER ESTIMATE SELECTION I hereby authorize the below repair work to be done along with necessary materials,You and your employees may operate You are entitled to a price estimate for the repairs you have authorized.The repair price may be less than the estimate but vehicle for purposes of testing,inspection or delivery at my risk.An express mechanic's lien is acknowledged on vehicle to will not exceed the estimate without your permission.Your signature will indicate your estimate selection. secure the amount of repairs thereto.You will not be held responsible for loss or damage to vehicle or articles left in vehicle 1.I request an estimate in writing before you begin repairs. _.._.___...._�__._.. _._.__..__..�_._ incase of fire,theft,accident,damage from freezing due to lack of antifreeze or any other causes beyond your control. 2.Please proceed with repairs but call me before continuing CUSTOMER SIGNATUREX_ if price will exceed S �J«. 3.1 do not want an estimate. ESTIE,IATED PRICE OF REPAIRS ADDITIONAL WORK AUTHORIZED BY:,.,.___,.__,__ M vnu want the renlared naris you are entitled to?'I ]YES 11110 Name