186266 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 362147 Page 1 of 1
ONE CIVIC SQUARE CUSTOM TRUCK AUTO INC
CHECK AMOUNT: $107.45
CARMEL, INDIANA 46032 17249 FOUNDATION PARKWAY
WESTFIELD IN 46074 CHECK NUMBER: 186266
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 8779 107.45 AUTO REPAIR MAINTEN
C0
CUSTOM TRUCK AND AUTO, INC
17249 FOUNDATION PARKWAY
WESTFIELD IN 46074
317 -896 -5956
6!1!2010 9:24 AM page 1
Invoice 8779
FIRE DEPARTMENT CARMEL
1 CIVIC SQUARE
CARMEL IN 46032
-fold here
Vehicle 1999 GMC Truck Suburban K1500 1/2 Ton 4WD 5.7 L 350 Tag /State :57713 IN
VIN 1GKFK16R6XJ810323 Color Red
Fleet 2263
Created 6/1/2010 9:12:36 AM Odometer In 57713
Complete 6!112010 9:24:21 AM Odometer Out: 57713
Invoiced 6!112010 9:24:21 AM
Contact BOB (664 -0958)
Qty Code/Tech* Reference Description Condition Unit Price Price
CB* EVACUATE, CHARGE PERFORMANCE TEST $70.00
3. CB* REFRI R134a New $9.90 $34.65
Labor $85.00 less discount $15.00 $70.00
Parts........................ $34.65
Sublet/Misc. $0.00
SHOP SUPPLIES $2.80
ChargesI $0.00
Sales Tax Tax Exempt 0031201550020 $0.00
Total Due $107.45
Tech Certification
CB
III 111fllflll�lllllllllllllillll
VOUCHER NO. WARRANT NO.
ALLOWED 20
Custom Truck Auto, Inc.
IN SUM OF
17249 Foundation Parkway
Westfield, IN 46074
$107.45
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 8779 43- 510.00 $107.45 1 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
7 2010
f n 11 7
o
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev, 1 5)
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))
8779 4551 $107.45
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