332712 11/21/18 oat t 2
CITY OF CARMEL, INDIANA VENDOR: 366480 �9�(p
• ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $*****1,459.00*
CARMEL, INDIANA 46032 ATTN:AR DEP MENT CHECK NUMBER: 332712
ETON PO 60X CHECK DATE: 11/21/18
G AY WI 54305-1630
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 830109116 1,459.00 OTHER EXPENSES
VOUCHER NO. 183313 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor# 366480 IN SUM of$ ACCOUNTS PAYABLE VOUCHER
POMP'S TIRE CITY OF CARMEL
PO BOX 1630 An invoice or bill to be properly itemized must show: kind of service,where performed,
GREEN BAY, WI 54305-1630 dates service rendered, by whom, rates per day, number of hours, rate per hour,
numbers of units, price per unit,etc.
Payee
1459.00 366480 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR POMP'S TIRE Terms
Carmel Water Utility PO BOX 1630 Due Date
BOARD MEMBERS
I hereby certify that that attached invoice(s), GREEN BAY,WI 54305-1630
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
830109116 01-6500-04 $926,44. and received except 11/6/2018 830109116 $926.44
830109116 01-6500-05 $532.56 11/6/2018 830109116
$532.56
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_
Clerk-Treasurer
SHPN577704405
POMP'S TIRE-LEBANON INVOICE #: 830109116
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 JGM
REF NUMBER: DR0186675
FAX NUMBER: 3177332053
BUSINESS: 317/733-2855 0
SALESMAN: RODNEY RICHARDSON
INVOICE DATE: 11/02/18 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
-------------------------------------------------------------------------------
PRODUCTMECHANIC QUANTITY PRICE F.E.T. EXTENSION
----------------------
P255/70TR17 DESTINATION LE2 OWL 4 118.59 474.36
F136043
TIRE USER FEE - IN 4 .25 1.00
Registration: Serial VNOCDE10818 Quantity 2
Registration: Serial VNOCDE10418 Quantity 1
Registration: Serial VNOCDE10718 Quantity 1 O
235/70TR17/XL DESTINATION LE2 WL 4 106.02 424.08
F097776 �f
TIRE USER FEE - IN 4 .25 1.00
Registration: Serial VNNDDE12418 Quantity 1
Registration: Serial VNNDDE12918 Quantity 1
Registration: Serial VNNDDE12317 Quantity 1
Registration: Serial VNNDDE13418 Quantity 1
LT245/75R17/10 TRANSFORC AT2 OWL 4 129.64 518.56 Oj
F000184
TIRE USER FEE - IN 4 .25 1.00
Page 1
SHPN577704405
Registration: Serial VN43TF22218 Quantity 1
Registration: Serial VN43TF22318 Quantity 1
Registration: Serial VN43TF22418 Quantity 2
PASSENGER. SCRAP DISPOSAL FEE 13 3.00 39.00
PDISP
CM 6479827618 T7
MERCHANDISE: 1417.00
OTHER: 42.00
OFFICE COPY INVOICE TOTAL: 1459.00
GOVERNMENT 1459.00
***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 2
REMITTANCE ADDRESS:
POMP'S TIRE SERVICE, INC. POMP'S TIRE SERVICE, INC. �o
ATTN: AR DEPARTMENT
P.O. BOX 1630 �`��
GREEN BAY, WI 54305-1630 TIRE SERVICE,INC.
POMP'S TIRE—LEBANON WORK ORDER #: 830109116
1316 WEST SOUTH STREET
AGE: 1
LEBANON, IN 46052
765/482-4359
CUSTOMER: CITY OF CARMEL WATER OPER
3450 W 131ST STREET
.2266
CARMEL, IN
46074
CREATED BY JGM
FAX NUMBER: 3177332053
BUSINESS: 317/733-2855 0
SALESMAN: RODNEY RICHARDSON
WRK ORD DATE: 10/23/18 TERMS: 1 PMT DUE 10TH F MON AFTR INV
PRODUCT: MECHANIC QUANTITY PRICE .F. T. EXT-ENSION
P255/70TR17 DESTINATION LE2 OWL %k 4 118.59 474.36
F136043
TIRE USER FEE — IN 4 .25 1.00
Registration: Serial Quantity 1
235/70TR17/XL DESTINATION LE2 WL — 01 4 106.02 424.08
F097776 �1
TIRE USER FEE — IN 4 .25 1.00
Registration: Serial Quantity 1
LT27/10 TRANSFORC AT2 OWL _�t1A10 4 129. 64 518.56
F000184
TIRE USER FEE — IN 4 .25 1.00
Registration: Serial Quantity 1
MERCHANDISE: 1417.00
OTHER: 3.00
OFFICE COPY WORK ORDER TOTAL 1420.00
THANK YOU FOR YOUR BUSINESS,! ! ! !
Printed Name "'c J r C� �C Signature ? L
LUG NUTS MUST E RE—TORQUED AFTER 50-100 MIL
*** DO NOT PAY FROM THIS WORK ORDER *** THIS IS NOT AN INVOICE ***
A finance charge of 1.5°lo 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 don 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 delive y 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 b 9 held responsible for loss or damage to vehicle or articles lelt in vehicle
1.1 request an estimate in writing before you begin repairs. in case of Bre,theft,accident,damage from freezin 1 due to lack of antifreeze or any other causes beyond your control.
2.Please proceed with repairs but call me before continuing CUSTOMER SIGNATURE X
it price will exceed 3
3.1 do not want an estimate. ADDITIONAL WORK AUTHORIZED BY.
fin vnn want tha rantarad nartc vnn aro ontillod tn7 i�YFC Fl N(1 ESTIMATED PRICE OF REPAIRS