334141 01/04/19 ®� CITY OF CARMEL, INDIANA VENDOR: 370797
ONE CIVIC SQUARE POMP'S TIRE-LEBANON CHECK AMOUNT: $*******800.40*
CARMEL, INDIANA 46032 1316 W SOUTH STREET CHECK NUMBER: 334141
LEBANON IN 46052 CHECK DATE: 01/04/19
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 830111151 800.40 OTHER EXPENSES
VOUCHER NO. 183708 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995)
ALLOWED 20
Vendor# 366480 IN SUM OF$• ACCOUNTS PAYABLE VOUCHER
POMP'S TIRE -L660r1'50-NS CITY OF CARMEL
{.r;}.ggl(.1� t Nb Civ/ 5oa TQC 57— An invoice or bill to be properly itemized must show: kind of service,where performed,
M Wf r^^$§ 163-210-0 dates service rendered by whom rates per day, number of hours rate per hour
VI�,CCI�rZ1a'S-1�YYl JT7 / / / / /
jam( �-d�o5 Z. numbers of units, price per unit,etc.
Payee
800.40 366480 Purchase Order No.
ON ACCOUNT OF APPROPRATION F R 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
830111151 01-6500-05 $800.40 and received except 12/27/2018 830111151, $800.40
I
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
SHON577838973 (002)
POMP'S TIRE-LEBANON INVOICE #: 830111151
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: DR1049574
FAX NUMBER: 3177332053
BUSINESS: 317/733-2855 0
SALESMAN: RODNEY RICHARDSON
INVOICE DATE: 12/27/18 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
--------------------------------------------------------------------=----------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
LT265/70R18/10 DYNAPRO AT RF10 4 199.85 799.40
H2020252
TIRE USER FEE - IN 4 .25 1.00
Registration: Serial BC61RFH1817 Quantity 2
Registration: Serial BC61RFH1917 Quantity 2
ENT HANKOOK 12/27/18 DKR
MERCHANDISE: 799.40
OTHER: 1.00
OFFICE COPY INVOICE TOTAL: 800.40
ON ACCOUNT A/R 800.40
***A COPY OF THIS INVOICE HAS BEEN EMAILED**
THANK YOU FOR YOUR BUSINESS! ! ! !
Page 1
REMITTANCE ADDRESS: POMP'S TIRE SERVICE INC: 4^�
POMP'S TIRE SERVICE, INC. , �Q 0�
ATTN: AR DEPARTMENT
P.O. BOX 1630
GREEN BAY, WI 54305-1630 ` TIRE SERVICE,INC.
WORK ORDER #: 830111151
POMP'S TIRE—LEBANON
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
FAX NUMBER: 3177332053
BUSINESS: 317/733-2855 0
SALESMAN: RODNEY RICHARDSON
WRK ORD DATE: 12/03/18 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
PRODUCT � " MECH � C� �QUAN ,` L'RTCE F E` EXTENSION ups
LT265/70R18/10 DYNAPRO AT RF10 4 199.85 799.40
H2O20252
TIRE USER FEE — IN 4 .25 1.00
Registration: Serial Quantity 1
MERCHANDISE: 799.40
OTHER: 1.00
OFFICE COPY WORK ORDER TOTAL: 800.40
THANK YOU FOR YOUR BUSINESS! ! ! !
Printed Name Signature
LUG NUTS MUST BE RE—TORQUED AFTER 50-100 MILES.
*** DO NOT PAY FROM THIS WORK ORDER *** THIS IS NOT AN INVOICE ***
A finance charge of 1.5%per month 18%APR)will be added to the un aidbalance after 30 days',
CUSTOMERESTIMATE 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,aceldent,damage from freezing due to lack of antifreeze orrany other causes beyond your control.
2.Please proceed with repairs but call me before continuing CUSTOMER SIGNATURE Xuicr�
if price will exceed $
3.1 do not want an estimate. rl ADDITIONAL WORK AUTHORIZED BY;.
Do you want the replaced parts you are entitled to?E]YES [I NO ASTIMATED PRICE Of REPAIRS A.M. Name