319131 11/30/17 �4q+. CITY OF CARMEL, INDIANA VENDOR: 00351179
3 ONE CIVIC SQUARE FIRESTONE TIRE & SERVICE CENTER CHECK AMOUNT: S......**33.13*
CARMEL, INDIANA 46032 PO BOX 403727 CHECK NUMBER: 319131
9M, o ATLANTA GA 30384-3727 CHECK DATE: 11/30/17
«ON
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 4231500 180971 33.13 OIL
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
vendor# 00351179 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
FIRESTONE TIRE&SERVICE CENTER IN SUM OF$ CITY OF CARMEL
PO BOX 403727 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.
ATLANTA, GA 30384-3727
Payee
$33.13
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
180971 42-315.00 $33.13 1 hereby certify that the attached invoice(s),or 11/14/17 180971 Oil Change $33.13
2200 2200 2200 2200
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
Wednesday, November 29,2017
Jeremy Kashman
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
Customer Invoice FIRESTONE COMPLETE AUTO CARE Service Advisor:
180971 CARMEL 05 TISH
11/14/2017 1314 S RANGE LINE RD 317.848.5886
CARMEL, IN. 46032-2932
2016 FORD ESCAPE SE
CITY OF CARMEL, BUILDING & CODE 1.6L L4 FI GAS. VIN X DOHC
1 CIVIC SQ Lic#: 33500 IN Vin#: 1 FMCU9GXXGUA55305
CARMEL, IN 46032-2584 In: 11/14/17 9:57AM Mileage: 19,910
317.460.3290 xkurt Out: 11/14/17 11:05AM
Store# 020753 COMMERCIAL
Rev Hist Unit Extended Job
_Description ____ /Article# ID___ Qty __ Price __ Price __Total
COURTESY CHECK 05
COURTESY CHECK 7046930 06NN 1 N/C N/C
STANDARD OIL CHANGE UP TO 5:QTS 05 33.13
4.3 QTS. --
MOTORCRAFT SAE 5W-20 Full Synthetic Motor Oil,or-MOTORCRAFT::SAE 5W=20 Premium
Synthetic Blend Motor Oil i� ;" ' �, �lt,
The Manufacturer recommends an.Oil Change when an associated dash board indicator light is-
lit...See
sIit...See Owner's manual for specific requirements.;, - _� „, ; , ry ;1 ,1 ' <N
PZ21 OIL-FILTER <' �;7058149 06NN -. 1 `_ .4.24.:-, �, ', 4.24
5W-20 QS ADV DUR GF5 OIL- UP-TO 5 QTS 7034653 06NN 1 22.10 22.10
USED OIL FILTER RECYCLING CHG (1) 7075051 06NN 1 2.54 2.54
OIL CHANGE LABOR 7029718 06NN 1 4.25 4.25
Technician(s):
06 DRAKE
Payment History: Summary:
33.13 Parts 26.34
Total Tendered 33.13 Labor 6.79
Shop Supplies 0.00
Sub-Total 33.13
Tax Exempt(31201660) 0.00
Total $33.13
1 have received the above goods and/or services. If this is a credit
card purchase, I agree to pay and comply with my cardholder
agreement with the issuer.
+LZOO — 42 3 i S OU
Customer Signature
All parts are new unless otherwise specified.
Declined Work:
ALIGNMENT SERVICE (12-MONTH WARRANTY)
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STD FCAC LASER 7008335-48110392 REV 11/11 '
Page l ON-`- _ r ��.. i t e-ffl a`trn
See reverse side for Warranty Information ���� 160324.503001
Courtesy Check
Inspect All Items in Top Section
❑SOHC ❑OHV ❑DIESEL Trans. Mto
Years Make �e14 Model IfTapez Eng.Size ❑DOHc ❑HYBRID Type ❑Manu
V _
NI I F KI� I I U I q I(� I IX 1 I-V IT i T I� • r^�0 Irk I Hubcap Missing Y '6 Windshield Cracked Y Scratches/Den N
MILEAGE: o `� Lic.# 04) State Inspection Due Month Year
intenance Services/Starting Tire�; and Tire Maintenance
Inspect Visual Sched. Why Recommended + Tire Size: Speed Run Flat Y I
OK SUG REO Maint.
— I Raring �)
Wiper Blades lJ 'D E]Front ❑Rear R 2� TPMS T/ P
Head.Lights t _ n 0 C C( C J
Visual Tread Depth
Mini Lights LA 17 0 ❑Brake ❑Tum ❑License ❑Parkin Inspect 32nds ❑FWD ❑RWD ❑4WD/AWI
t Signal Plate g oK SUG REQ Outer Inner
Air Filter Lil �y p �M P Left Front { ❑ dgewear ❑ Cracking
��0 y l I /4 G 6 PSI In: PSI Out: ,dj i t
"abin d � t"'� ❑ Cupping �10 Na is
( J�
la
4tr Filter 1 i �J �"b CUM
❑ Irregularity ❑ No R13 pairable
PCV Valve I
'�'r --� Right Front '" -
Washer Fluid �l E PSI In: PSI Out:
�Edgewear ❑ Cracking
_f �-�} ❑ Cupping ❑ Nails
l jt J6 9
Oil Level' —1 aa� f ❑• CUM
❑ Repairable
❑ Irregwadry ❑ Non-ReRM
pairable
Power Sir. If t]i
-luid Level ! +�I Right Rear / i r�Eagewear ❑ Cracking
Master Cyl.Fluid 01,12111
Psl m: Psl out: t"' f � ❑ Cupping ❑ Nens
LA
Level r I: ❑ Brake Inspection rl 1 S ❑ cuts ❑ Repeimhle
3rake Fluid Flush p d ❑ I agciady ❑ Non-Rape able
i o er arts er mil on
trans.Service ❑ Flush Left Rear •, } F [ L� dgewear ❑ cracking
auto/Manual 1'i ❑ Pan Service PSI In: PSI Out: �j f / F I + ❑ Cupping ❑ Nails
DOOlant (" - L —r-S N r i i g ❑ Cuts ❑ Repa able
-eve /Flush T71T e ✓� if 4 �p
'� 't 4 ❑ Irregularity ❑ Non-Repairable
3oolant Hoses ❑ Upper ❑Lower ❑Bypass ❑Heater
spare /� ❑ Edgewear ❑ Cracking
Salts ❑"V" y j ❑ALT El Ps Belts PSI In: PSI Out: ✓ �/ ❑ Cupping Nails
❑Se ) :I ._.I ❑A/C ❑AP 1 2s3 4 ^ ❑ coca ❑ Repa retie
3D 18 ❑ Good ❑Marginal ❑ Replace ` ,�' ❑ Irregularity ❑ Nan-Repairable
3attery El Cable Ends/Cables ❑Nes ❑Hold Downs Tire
accessories Maintenance [IRotation El Balance
1_ i r
3attery Gard ', ❑ Corrosion ❑Preventive Alignment Check 1, aintenance Tire Wear
Complete Inspection '
In Addition to The Above Inspect All Items Bellow
Maintenance Services/Starting Brakes ABS N YJES ENO
Visual Sched. M �'
Inspect OK SUG REO Me int.' + Why Recommended + o e F{ tiPadsgreater than 6mm(Disc)or Shoes greater than 2:"4mm(Drum)
'tart/Charge i i t lnmmorltihan6n6rri(DLsc)orShoes=1
reaKr"LFcsrtt6rtvn atom
est I i T7 ,z€Docuinen4,vehlcl®;specific measurements&minimum'specifrcati®ns b®]ow
3elt Tensioner i eads ess.than 3mm3mm(Disc)or Shoes___ It an 1.6mmr(�r�m)
s Dacumenttvehlcle specific measurements&minimums ecifidationa below
Spark Plugs LF Pad RF Pad
eas Actual Filter MMeaG
Fuel System —t
Service I C y' 4 MM Actual Machine Machine MMAdual
gnition Wires To R1, To
✓alve Cover ��7 �. Discard Discard
3asket I L M Spec. At AL MM Spec.
'ower SteeringII - ❑ ❑ Return. LR Pad/Shoe . . RR Pad/Sho
lose ! Pressure
riming Beit { Meas EllMeasal
n
.
MM Actual Machine
To , Moachins • MM Actual
I Exhaust FE-1
Exhaust System JI ❑Intermediate Pipe ❑ Muffler ❑Tailpipe Discard Dscard
EIMM Spec i
At DMM Spec.
Steering and Suspension
•)I i P Rear Clean/Adj
J-Joint 11Lj Front ❑Rear
i Brake Hose(s)
Idler/Pitman Ann L3TIO
, ❑Idler ❑Pitman
Parking Cables
13
Center Link ` Other Brake Hardware Cali er thine lRe ack
Bushings ❑Control Arm ❑Sway Bar ❑Rear f J i K Services p Cylinder p
El FrontNotes:
Link Pins ❑Front ❑Left ❑Right / t
EI—_I
El Rear C1 Left ❑Ri ht Ras 6b4f-S —C,U00,U� — �fo-/GG �tiSPee o„�
re Rod Ends O IFD iu,❑L Out ❑L In - ❑R In ❑R out ❑Sleeve(s)
Ball Joints ❑L Upper ❑R Upper
❑L Lower ❑R Lower Sec _ Actual
'ac'
&Pinion r`1 fl—f
Assembl cl—J
CV Boots Vin,`[:]❑L Out ❑L In ❑R In ❑R Out
CV Joints ❑ ❑L Out ❑L In ❑R In [:3 R Out
❑Front ❑Left ❑Right
Struts L1 Rear E]Left
❑Ri ht
Shocks I �I (� `�
El Front E]Left E]Right
r Il-1 r3-1❑Rear ❑Left ❑Ri ht
0 ( Repair/RentaeemeittSdgnesfed •i' Repair//iReplacementReguiied'
ed & i) Glose to end,of useful Irfe r I A)NoJoMg rpee5rms intended purpo
ca talNa 2)¢Iitlress customer requost!need/conuenience B)"Doess not meet design�n specfficat'on
3)Complyhwith rnanufacturerrecommendation G)Missing STEP 5 STEP 7
4}'Technicianrecommendationfrom!experience INSPECT BY REINSPECTED BY