308640 02/28/17 f C"q-
�'� "�� CITY OF CARMEL, INDIANA VENDOR: 00350983
,.�; ® ONE CIVIC SQUARE R &T TIRE&AUTO -NOBLESVILLE CHECK AMOUNT: $***'***117.57*
s9, =q: CARMEL, INDIANA 46032 17016 CLOVER ROAD CHECK NUMBER: 308640
M�r'oN�, NOBLESVILLE IN 46060 CHECK DATE: 02/28/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4232000 N01FGT 117.57 TIRES & TUBES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00350983
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
,
R &T TIRE &AUTO- NOBLESVILLE IN SUM OF$ CITY OF CARMEL
17016 CLOVER ROAD 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.
NOBLESVILLE, IN 46060
Payee
$117.57
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Engineering
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
N01 FGT 42-320.00 $117.57 1 hereby certify that the attached invoice(s),or 2/15/17 N01 FGT Tire for E-1 $117.57
2200 201 2200 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, February 21,2017
Jeremy Kashman
Director
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
• i✓ 1
R & T Tire-Noblesville R&T Frankfort(765)654-5588
17016 Clover Rd R&T Lebanon(765)482-5027
R&T Sheridan(317)758-4456
RT
Noblesville,IN 46060 R&T Tipton(765)675-6775
317-773-3130
Si1mae1965 -
Store Location Store Phn Date Time
R & T Tire/Auto - NOB (317) 773-3130 02/15/17 03:28 PM
17016 CLOVER RD file id: NOB-66701 Page 1
NOBLESVILLE, IN 46060
Your P/0 A/R Acct Terms
Inv: N01FGT N02655 1 ST 10TH
Sold-To: Type - Payment
CARMEL ENGINEERING DEPT. (E $
1 CIVIC SQUARE $
CARMEL, IN 46032
Total $ 0.00
*MEMBER OF THE GOODYEAR TIRE & SERVICE NETWORK** 317-571-2441
Qty Shp B/O Item Number Description =$'/W FET Price Amount Init's
1 GY755206383 235,-/70R16 106T SL ASSUR,CS FUE 102.87 102.87 5,494
dot# M74EJH1R0716 §h
„ ' r
1 EPA §STATE TIRE FEE (INDIANi'.) r 0.25 0.25 5, ---
iz ,
1 INSTALL MOUNT-COMPUTER BALANCE 10.95 10.95 5,494
1 093002000 TIRE`=DISPOSALS 3.50 3 .50 5,494
- REPLACE, !—LEFT;12EAR TIRE
z
d �
'/Info: 2010 FORD ESCAPE WHITE , VIN 1FMCU5IC3XAKB4086"
ic# 67111 IN Unt# E1 Mil 95380 `K x
Last: , // xif .
—____—__—_ 4 y S q >� V_ ______
E '� Sub-Total
$117.57
IN GOV'T, 0.000%
$0.00
•2,'L 00 — 424200 Total: $117.57
NewPymt: $0.00
Total Due: $117 . 57
T
Received By: "``'"SP' Chuck Godby
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