189778 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 00351179 Page 1 of 1
0 ONE CIVIC SQUARE FIRESTONE COMPLETE AUTO CARE
CARMEL, INDIANA 46032 Po Box 403727 CHECK AMOUNT: $482.95
ATLANTA GA 30384 CHECK NUMBER: 189778
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4232000 105998 482.95 TIRES TUBES
s custorner Invoice FIRESTONE COMPLETE AUTO CARE Service Advisor: I
„x.,,.1.05998 CARMEL 01 TRAVIS
09/03/2010 1314 S RANGE LINE RD 317.848.5886
rARMEL, IN. 46032
CITY OF CARMEL, BUILDING &CODE 7 2005 FORD ESCAPE HYBRID [WHITE] I.
ti,D.1 CIVIC SQ Lic 68648 IN Vin M 1 FMCU96H76KA26087 r
CARMEL, IN 46032 -2584 In: 09/02/10 10:04AM Mileage: 68,948
317.571.2418 xLISA Or 317.509.9182 xADAM Out: 09/03/10 8:22AM
Sto 020753 COMMERCIAL
Rev Hist Unit Extended Job
I
Description__ /Art_icl_e_# ID_ Qty _Price P rice_ Total I I
FIRESTONE TIRES WITH UNI -T, PACKAGE 01 422.96 M
054375 DESTINATION LE W! UNI -T P OWL P235170R16 054375 13NN 4 96.99 387.96 r f ,1', ;�:r
XL107S q10
ate,_ DOT# VN08D103210
DOT# VN08D103210
DOT# VN08D103210
DOT# VN08DIO3210 4, r
<r11r�I��K
INDIANA. TIRE FEE 7095$34 13NN 4 0.25 1.00
LIFETIME NEW TIRE WHEEL BAL -PARTS 7025194 13NN 4 2,00 8.00
+i LIFETIME °tvEW TI RE WHEEL BAL LABOR 7001725 13NN 4 3.00 12.00
t 1 LIFETIME RUBBER VALVE 7024341 13NN 4 1.00 4.00
TIRE DISPOSAL FEE (1) 7075078 13NN 4 2.50 10.00
y` TIRE INSTALLATION 7015016 13NN 4 N/C N/C
ALIGNMENTS 01 59.99
ALIGNMENT SERVICE 7004578 10NN 1 59.99 59.99
COURTESY CHECK 01
COURTESY CHECK 7046930 10NN 1 N/C N/C j
Technician(s): I
10 FRANKLIN PETRARCA 13 MALACHI BOWEN I
Payment History: Summary: "s
CommIDIr Acct 482.95 Parts
Total Tendered 482.95 Labor 82.99�;i
Shop Supplies 0 00
Sub -Total ���,,�482'95
Tax Exempt(31201660),1,O OOi
I Is?�;11 I
Total 4 Ali
have received the above goods and /or services. If this is a credit
card purchase, I agree to pay and comply with my cardholder
agreement with the issuer.
Customer Signature
Initial here to indicate you have received
the Tire Maintenance Warranty Book.
10' 'parts are new unless otherwise specified.
.3
I 1
I {y
TELL US ABOUT YOUR EXPERIENCE AND RECEIVE $10 OFF YOUR NEXT PURCHASE OF $25 OR MORE! 1,1r Ir
1) For a short survey Call 1- 800 859 -9203 or logon to www.FirestoneSurvey.com; enter code 020753 105998
2) Write redemption code here: Offer expires 6 months from date of invoice, good at all participating locatid `I 11
�y
Must have valid redemption code. May not be used to reduce existing debt. No copies accepted.
COMMITTED TO PROVIDING A POSITIVE CUSTOMER EXPERIENCE
Page 1 or I Inv1 100608.306104i't.i �u�.
TES
INSPECT ALL ITEMS IN T OP SECTIO
Year Make L M odel —F 5 El SOHC 0011V DIESEL Trans. ❑Auto
ERgSi. ❑DOHC El HYBRID Type" al
C Hubcap Missing Y N Windshield Cracked Y s Y N Scratches /Dent N
MILEAGE Lic. State Inspection Due Month Year
INSPECT VISUAL scHED. WHY RECOMMENDED TIRE SIZE: SPEED RUN FLAT Y N
OK SUG REQ MAINT RATING
F
WIPER BLADES U ❑FRONT ❑REAR T TPMS Y N
HEADLIGHTS R J J
TURN LICENSE INSPECT VISUAL TR DDDGS ❑FWD ❑RWD ❑4WDlAWD
MINI LIGHTS U ❑BRAKE SIGNAL E:] PLATE PARKING
OK SUGHBECL OUTE INNER
AIR FILTER SI IN_
LEFT FRONT �j EDGEwEAR CI CRACKING
PSI OUT: CUPPING NAILS
CABIN' CUTS REPAIRABLE BLE
AIR FILTER 3 o IRREGULARITY'
PCV VALVE
RI HT FRONT L] EDGEwEAR El CRACKING
WASHER FLUID PSI�� O a CUPPING NAILS
OIL LEVEL y CUTS REPAIRABLE
I IRREGULARITY
POWER STR.
FLUID LEVEL HT REAR I El EDG EWEAR CRACKING
MASTER CYL FLUID PSI IN: PSI OUT: I o Y �I J,r CUPPING NAILS
LEVEL F1 BRAKE INSPECTION I�I CUTS REPAIRABLE
BRAKE FLUID FLUSH TEST STRIP FAILURE Y N I IRREGULARITr P
ti
TRANS. SERVICE FLUSH REAR w -"F- n Ir I. 1 EDGEwr =AR El-CRACKING.-
MANUAL El PAN SERVICE PSI OUT R CUPPING NAILS
AUTO/
COOLANT h CUTS REPAIRABLE
LEVEL /FLUSH TYPE �t 'l IRREGULaRm P
COOLANT HOSES ❑,UPPER. LOWER BYPASS HEATER
SPARE EDGEWEAR CRACKING
VA "V" ❑ALT UPS BELTS PSI IN PSI OUT: CUPPING NAILS
BELTS ❑SERP I ❑A /C ❑AP 1 2 3 4 El CUT 11 REPAIRABLE
BATTERY I GOOD F-1 MARGINAL REPLACE El IRREGULARITY A BLE
ED- 18TFST L
BATTERY El ACCESSORIES CABLE ENDS /CABLES NOEG El HOLD DOWNS TIRE MAINTENANCE ❑ROTATION ❑BALANCE
BATTERY GARD CORROSION PREVENTIVE ALIGNMENT CHECK MAINTENANCE TIRE WEAR
IN 1 0
INSPECT VISUAL sCHED. WHY RECOMMENDED vSUAL WHY RECOMMENDED
OK SUG REQ MAINT. IN SPECT OK SUG RE
SESRT /CHARGE FRONT PADS L. A RF
32".. 3Pors
BELTTENSIONER U OR
FRONT CALIPERS WORN ABS Y N WORN
SPARK PLUGS LF ROTOR RF ROTOR
FRONT ROTORS
FUEL FILTER ACHINETO: DISCARD:
FUEL SYSTEM ACT. ACT.
SERVICE REAR SHOES LR RR
IGNITION WIRES PADS I- 32— oR °5
CAUPERS/ ABS Y N
VALVE COVER REAR 1NORN WORN
LR DRUM /ROTOR
OR
WHEEL CYL.
GASKET DRUMS/ RR DRUWROTOR
POWER STEERING PRESSURE RETURN REAR ROTORS
HOSE
MACHINETO: DISCARD:
TIMING BELT ACT. ACT.
EXHAUST HARDWARE! I I FRONT El REAR
ADJUSTERS L_
REAR CLEAN!
'EXHAUST SYSTEM
INTERMEDIATE PIPE MUFFLER TAILPIPE ADJUST
WHEELBEARINGREFACK WHEEL BEARING FRONT BEARINGS/ FRONT
1 I BEARINGS /SEALS REPACK REAR SEALS REAR
U -JOINT FRONT REAR BRAKE HOSE(S) Li LQJ LF RF LR RR
IDLER /PITMAN ARM U IDLER F PITMAN PARKING CABLES LEFT RIGHT FRONT
CENTER LINK NOTES:
BUSHINGS ❑CONTROL ARM ❑SWAY BAR El FRONT
REAR
LINK PINS ❑FRONT ❑LEFT ❑RIGHT
❑REAR ❑LEFT ❑RIGHT
TIE ROD ENDS U L OUT L IN E] R IN ROUT SLEEVE(S)
L UPPER R UPPER
BALL JOINTS El L LOWER R LOWER SPEC ACTUAL
RACK PINION
ASSEMBLY
CV BOOTS LOUT L IN R IN ROUT
CV JOINTS L OUT
E] L IN R IN ROUT
STRUTS
El FRONT ❑LEFT ❑RIGHT
❑REAR ❑LEFT ❑RIGHT
SHOCKS L FRONT ❑LEFT ❑RIGHT
REAR CLEFT LRIGHT
OKp. REPAIR /REPLACEMENT SUGGESTED RF,P.AIR(RE!?L GEMENiAAfOUINED
CHECKED 1) CLOSE TO ENO OF USEFUL LIFE 109 RFO P Sy !DE�O P SE V
ACCEP•T�Bf E 2) ADDRESS CUSTOMER REQUEST /NEED /CONVENIENCE B) Of5 NO OESIG WAR ON
3) COMPLY WITH MANUFACTURER RECOMMENDATION MIS) STEP 5 STEP 7
4 TECHNICIAN RECOMMENDATION FROM EXPERIENCE INSPECTED BY RE- INSPECTED BY
VOUCHER NO. WARRANT NO.
Firestone Complet Auto Care
i ALLOWED 20
1 IN SUM OF
P.O. Box 403727
Atlanta, GA 30384
$482.95
ON ACCOUNT OF APPROPRIATION FOR 1
I
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1192 105998 42- 320.00 $482.951 1 hereby certify that the attached invoice(s), or
j bill(s) is (are) true and correct and that the
I materials or services itemized thereon for
i which charge is made were ordered and
i
received except
Friday, September 10, 2010
hector, D ?�s
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 105998 Tires Unit 92 Adam $482.95
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
20
Clerk- Treasurer