187911 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 173000 Page 1 of 1
ONE CIVIC SQUARE KERR REFRIGERATION
CHECK AMOUNT: $183.00
CARMEL, INDIANA 46032 130 SOUTH DAVIDSON STREET
INDPLS IN 46202 CHECK NUMBER: 187911
CHECK DATE: 7121/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350000 32207LI5 183.00 EQUIPMENT REPAIRS M
IbI.Ad L A Iljole— 7U 1tAiA1 1l .6 47 2 't,�AVICIC .3:p 2- C
LAST NAME FIRST NAME INVOICE NO.
w r) 0 i p�tvf� p�n�ps 3 2 2 0 7 L 15
S_TREET_ ADDRESS
-'6 }yq j�/ v ls v aa p.fltNMo
I I I 1 1 I f 1 I_ r I r r ��LSIL�"I<1CV�'4t '£+SC`�VliiLa SERVICER ACCOUNT NUMBER
CITY STATE ZIP CODE
I I Jrl I Ifs.! T I V/",' I I I I I I g5 Q SERVICERS'ACCOUNT NUMBER WITH PO
HOME PHONE
_WORK-PH j NE
I ONSUNkER'S REQUEST
C S =DATETURCHASED
I�(�(�/�
_BRA D 1 L! u I N, PRODUCT TYPE_ f fN\r �A.� �J p'a(isc 4�Pi QI.GJ�
�yi I 1 I I I CJ (/I'���' I `r a l I—J
..I :2e' s i I J1,1 O,°". I I K^ g QJ f FAULT CODE DAAT-�E CALL RECEIVED
_MODEL NUMBER- I UI r t V i/ I v� f i U t_J L- -J 4 3 <3 R 1.�'.-J
Mb 1 air I� i i
I C E S P C'Y F t O RM �i �1) ���y I� DATE REPAIRED
SERIAL NUMBER �j +�C:i.,V�.el) O I et5' 6A! 6Xgj �h�c>gL �IC3 �M WN'r�rJ
l
I I I _1 I-) r I
SERVICE AGREEMENT CONTRACT NUMBER j'�j JOB DEFECT CODE
I I I -L ESTIMATE e t 'T P V R/ �t f"iC4 I�
-f,�, OF REPAIR r T
F U 01�
Q CONTRACT ISSUER: s2m f /��gJ
k I MICRO LEAK READING
I PARTS CONSUMER EMAIL ADDRESS I;PDD AA WITH MA�NUFACTURI�rE�R-�I BEFORE AFTER
'V
EXPIRATION TIME STARTED LABOR
Gr I I I i� I saLES -raX, WARRANTY PART WARRANTY CONSUMER
TIME COMPLETED TIME ON JOB -I
r.JJ' 1 �q tr l
r TIMATE SPECIAL 111 1 n
11 110 11
Q. r I Ifiy i I I i raL AUTHORIZATION 1 11
OTY PART NUMBER INVOICE NUMBER PART COST
SUB TOTAL
l I �"�I( I PARTS
Q1 I V I L.J I J'� i �_�I I'_I L s D 11L�J t-� I HANDLING
EXTENSION:
DESCRIPTION: �1/� /q �q TOTAL
-0 Q l 76 l l I I I IJ,V PARTS
L__ L LJ L I L! L L� lJ L.J ICI P, I TOTAL MILES
TRAVELED
1
DESCRIPTION: EXTENSION:LI LI I TRIP I
I J
ti: CHARGE V
L_ I L__ LE l�� L 1� L �e ��i__� L_J I u
LI T t COMP. CALL
LABOR
DESCRIPTION: EXTENSION. I
1 l DIAGNOSTIC
E
1 r- I4
f i L _�i L .J II I1 11 iI �_I L H
STATE
LABOR
DESCRIPTION: E %TENSION: I.
1 f I i I I 'a i TAX
I�. J L_! L, _I �1 U U L� LJ l ��A
I DESCRIPTION: I EXTENSION: ENVIR.
c
MFG I MOTOR I SEALED UNIT NO. OLD MAG I MOTOR I SEALED UNIT NO. NEW- SELLING DEALER I DISTRIBUTOR' a FEE
Bob CL4akS OPP.6 .91-tV
0
The repairs have be�.pertormed in a manner satisfactory to me. METHOD OF PAYMENT TOTAL
CUSTOMER 4 f j AMOUNT
'Pow SIGNATURE I DATE CASH' CONTRACT CHECK# I 4 JJ
I have bee l dvised of the anti -tip device for my range. CHARGE I IIIIII VIII VIII VIII VIII IIIIII III IIII
VISA MC DISCV AMEX OTHER i t ff
CUSTOMER 12345F
SIGNATURE DATE AUTH. NO. EXPIRES
I hereby certify above service has been performed &p used. TRANSMITTAL NUMBER CONTROL NO. kr Auo ITEO Dv: OTH
th ER:
S GNATURE a e.• DATE L�1 It I L�J L
'An estimate as required (Section' 9844 of the California Business and'
Professions Code) for repairs shall be given to the customer' by the ser-
vice dealer, in vurit ng;- and the service dealer may not charge for ,work
done or. pars su;ppiied Tin excess of:.tfie estimate without prior consent of
the custi]Q' ner. Wh&e in writing, the service dealer may, charge a
reasonable lee for services provided in determining the nature of the mal-
function iri preparation_ of a written estimate for repair.. For information
contact-. _Bureau Electronic' and Appliance Repair, Department of
or sumer Affairs, Sacramento, GA 95814."
LOO ACJh9Vi TECH. NO. TIME DATE
CALL IF REVISED ESTIMATE LS OVER REVISED EST j APPROVED BY DATE TIME AM RECEIVED BY
PM
ES Mi A ED CHARGES 1NGLUDE GATELASTSERVICE SO TECH CR T DEALER P.O.
SERVICE CALL.
T�CH SERVICE DATE A] SP T ECH NO ESTIMATED TIME FOR COMPLETION COMPLETED
P!O DELIVERY I$_ WORKDAYS. AND.NOTIRED
c
PARTS PARTS USAGE WORKLOAD AND PARTS ORDERS
i l
R61 ESTIMATE COULD CAUSE DELAY BY X
TECHNICAL
PARTS 'OTHER COMMENTS
OTHER
TOTAL I
DATE TECH BIN Loc 7 ORDER
MIN CHARGE: �T j (NUMBER
NRD35O (4M) BACK
VOUCHER NO. WARRANT NO.
ALLOWED 20
Kerr Refrigeration
r IN SUM OF
130 S. Davidson Street
Indianapolis, IN 46202
$183.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 322071-15 43- 500.00 $183.00 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
JUL 1`9 2010
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. 1995)
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))
322071-15 $183.00
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
2a
Clerk- Treasurer