189732 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $64.75
CARMEL, INDIANA 46032 PO Box 195
FISHERS IN 46038
CHECK NUMBER: 189732
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00116620 64.75 EQUIPMENT REPAIRS M
126TH REYNOLDS ROAD (HWY 37 NO.)
P.O. BOX 195 FAST! Service at your Farm,
FISHERS, INDIANA 46038 Commercial Site or on the Road.
TIRE FISHERS 317 842 OR 1-800-444-5985
3 All Major Brands Available
Fax 317 -577 -3956
NAME? ADDRESS ACCOUNT NO. HOME PHONE -y REFERENCE NO.
GDGtRM 0
f�t17) �t7] c 4'�ii.:i
CITY IF CAREL P.O. NO. WORK PHONE DATE !TIME
i
C IVIC SQUARE n (317), 09103 1 D J ;IZt
RESALE NO. i VIN NO. WO ES NO.
YE 4"% WD000� 7`2?'B
EAR MAKE 1 MODEL
T LICENSE'NO, TAG NO, 1 NEXT INSP. DATE BAR NO.
snvE PArars
h
PROMISED DATE /TIME MILEAGE WRITTEN BY
ALL PANTS N EW UNLESS
v IN OTNERWISE'SPECIFIED r
s
ORIGINAL O, FREE ROTATION
REVISED (EVERY 5 'MILES)
REVISED 2
I acknowledge notice and oral approval of an increase in the original estimate price. ❑ROAD HAZARD WARRANTY
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PARTS O OTHERS LABOR
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1 511303 20X1000 -81'2 TURF TL t Sc00' 54.tR 1.00 INDIANA TIRE FEE 0.85
L T4 TIRE VALUE 2.00' 2, 1;Oa DISY" KOUNTT 5.00-
v 1.00 TIRE DISPOSAL PAS. i 3.50
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Rea an for original "4sti mate:
Any warranties on .the itemiltems soltl 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 IY 4o PER "MONTH (21% ANNUALLY' WILL BE CHARGED ON ALL�ACCOUNT PAST.DUE 30 DAYS „N ET'tt)[M1 PROX' a
I, THE UNDERSIGNED, HEREBY AGREE THAT IN THE EVENT 0F DEFAULT UN THEEPAYMENT OF ANY AMOUNT DUE, AND IF THIS ACCOUNT IS PLACED IN PARTS
THE'HANDS OF AN AGENCV'OR :A7TORN EY FOR COLLECTION OR, LEGAL ACTION,. TO PAR AN ADDITIONAL CHARGE EQUAL TO TH£ COST OF `a�" 0
COLLECTION INCLUDING. AGENCY AND ATTO HEY FEE AND COURT COSTS INCURRED ANo PERMITTED. BY. LAW GOVERNING THESE. TRANSACTIONS LABOR 8 .0
I hereby authorize the repau ork to be d along i the cessary aterials. You and your employees may operate' vehicle for .purposes of testing OTHER
Y o hel
spec4on; ordeilverya isk Anexpr me, 's ackn w dged an vehicle to secure the amount of repairs thereto. It is also understood that
u will not bed
X res able for. loss sma to ca d artic a -cars in case of fire, theft or any other cause beyond your control. SUBLET
Signature SUBTOTAL E4. 75
5
TAX 0. I 0
Rec'd By E. 7`'
TOTAL
CASH AMOUNT CHECK AMOUNT' CHECK NO C.G. AMOUNT C.C. TYPE C.C. APPROVAL CODE' ON ACCOUNT THANK
64.75 YOU!
W
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire Fishers
IN SUM OF
126THJ Reymolds Road (Hwy 37 NO.)
Fishers, IN 46038
$64.75
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# I Dept. INVOICE NO. ACCTXTITLE AMOUNT Board Members
1207 IN00116620 43- 500.00 $64.75 I 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
Friday, September 10, 2010
Director, Brookshirddolf Club
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))
09/03/10 IN00116620 Repair Tire $64.75
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