184710 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
t` ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $105.25
CARMEL, INDIANA 46032 PO BOX 195
FISHERS IN 46038 CHECK NUMBER: 184710
CHECK DATE: 4/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00113810 105.25 EQUIPMENT REPAIRS M
126TH REYNOLDS ROAD (HWY 37 NO.) FAST! Service at our Farm,
FISHERS, INDIANA 46038
P.O. BOX 195 Commercial Site or on the Road.
TIRE FISHERS 317- 842 -0544 OR 1- 800 444 -5985 All Major Brands Available
Fax 317 577 -3956
NAME ADDRESS ACCOUNT NO. HOME PHONE REFERENCE NO.
B ROOKSH (317)571-2427 I N00113810
BROWSHI`"F r' CLUB P.O. NO. WORK PHONE DATE TIME
12120 Bi;t,L AsHi r PARKWAY 317) 04/ 10:2
RESALE NO. VIN NO. WO ES NO.
CARNEL, IN 46033 W000075368
YEAR MAKE MODEL LICENSE NO. TAG NO. NEXT INSP. DATE BAR NO.
SAVE PARTS ALL PARTS NEW UNLESS PROMISED DATE TIME MILEAGE WRITTEN BY BS
Y N OTHERWISE SPECIFIED
ORIGINAL FREE ROTATION
REVISED 1 (EVERY 5,000 MILES)
REVISED 2
1 acknowledge notice and oral approval of an increase in the original estimate price. ROAD HAZARD WARRANTY
X
PARTS OTHERS LABOR ruin
1 574377 26X12.00 -12/6 NULTITRACCS 105.00 105.0 RUSSELL 420 -940
1.00 INDIANA TIRE FEE 0.25
Reason for original estivate:
Any warranties on the item(tems sold hereby are those made by the manufacturer. The seller, CLARK TIRE, hereby expressly
disclaims all warranties, either express or implied, Including any Implied warranty of merchantability or fitness for a particular
purpose, and CLARK TIRE neither assumes nor authorizes any other person to assume for it any liability in connection with the sale
of this item /items.
A SERVICE CHARGE OF 1V/% PER MONTH (21% ANNUALLY) WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS. NET 10th PROX.
1, THE UNDERSIGNED, HEREBY AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE, AND IF THIS ACCOUNT IS PLACED IN PARTS T b 0 1
THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION, TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF
COLLECTION INCLUDING AGENCY AND ATTOR Y FE AND COURT COSTS INCURRED AND PERMITTED BY LAW GOVERNING THESE TRANSACTIONS LABOR 0 2,
11lereby authorize thW a don ong w h the n essary materials. You and your employees may operate vehicle for purposes of testing OTHER inspection, or delivepres echan 's li acknowledged on vehle to secure the amount of repairs thereto. It is also understood that
you will not be held or age car as left in cars in case of fire, theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL
1
TAX D
Recd By 1fZ15. E
TOTAL
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C. AMOUNT C.C. TYPE C.C. APPROVAL CODE ON ACCOUNT
105 25 THANK
YOU!
VOUCHER NO, WARRANT NO.
ALLOWE D 20
Clark Tire Fishers
IN SUM OF
126THJ Reymolds Road (Hwy 37 NO.)
Fishers, IN 46038
$105.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# 1 Dept. INVOICE NO. ACCT #fTITLE AMOUNT Board Members
1207 IN00113810 43- 500.00 $105.25 hereby certify that the attached invoice(s), or
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, April 26, 2010
4
Director, Broo0hire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Fotrr No 201 (Rev 199:
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/22/10 IN00113810 Repair Parts $105.2
1 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
Clerk- Treasurer