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192624 12/10/2010 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1 ONE CIVIC SQUARE CLARK TIRE INC 0 CHECK AMOUNT: $171.40 CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD o� a CARMEL IN 46032 CHECK NUMBER: 192624 CHECK DATE: 12/10/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4232000 130170 171.40 TIRES TUBES rciA R 622C S. Rangeline Road "YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 46032 4 w (31.7) 844 -4839 riRE matio nal PEN NZQIL I, THE UNDERSIGNED, HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME, TILE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID. 1 FURTHER AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE, AND IF THIS ACCOUNT IS PLACED IN TI -IE 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 ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BY LAWS GOVERNING TI IESE TRANSACTIONS. A finance charge of 13A% Per Month will be charged on all Accounts 36 days Past Due. Annual Perce ❑rage Rate is 21 (Minimum 75) RE CEIVED BY SOLD TO: CARpa CLAY pfiR45 Ate REC 6356101 SHIP T0 .3AME tNV0itt#s 23017@ 1411 E. 116TH STREET CARIL IN 46032 CUST. PO. MAKE -MODEL ID# MILEAGE TEt�EFHONE `ROUTE` sLna SHIP VIA' ORDER PACE REMARKS (317 )571 -4144 0 1 NIA 136229 1 INVOICE PREVIOUS'SHIPPED INVOICE DATE TERMS NUMBER INVOICE NUMBER 1 /1Cl24z 130170 NET 14TH 11/16/10 14 :52:39 e DESCRfPTI,ON oR SIZE Q ANTITy ,UNIT T 'F E T_ EXTENSION STOCK NUMBER o�RS SHIPPED PREY. SHIP. PRICE 2 TIRES FOR REAR ON TRAILER 99020 ST205/75R15 MASTERTRAC STR (C) 2 2 79.95 02 .00 159.96 STEM EACH VALVE STEM 2: 2 2.50 02 00 5.00 SCRAP SCRAP TIRE 2 2 3.00 .00 6.00 TF INDIANA TIRE FEE 2 2 .25 .00 .50 METHOD (Y PA'f DIT: CHARGE: 171.40 CHANCE: .00 ©V I Purchase Descrt p titm P.O./ RorF I G.L# 1IPa— 2,3a 00 C) Budget Line Deser t i5 Purchaser Date Approval Dat 1' f T hank you for your busine5s ech: E o TAXABLE' w, r MISC PARTS LABOR TAX /q AMOUNT_ TAX" F.E.T. AMOUNT s FINUOfCE TOpTQL 171,40 171.41 "You're Riding On Our Reputation" ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 060700 Clark Tire Terms 622C S Rangeline Rd Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 11/16/10 130170 Tires for Large water trailer 171.40 Total 171.40 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 Voucher No. Warrant No. 060700 Clark Tire Allowed 20 622C S Rangeline Rd Carmel, IN 46032 In Sum of 171.40 ON ACCOUNT OF APPROPRIATION FOR 101 General Fund PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 130170 4232000 171.40 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 9 -Dec 2010 Signature 171.40 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund