195109 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE AUTO SVC
CARMEL, INDIANA 46032 1310 W SOUTH Sr CHECK AMOUNT: $2,122.16
LEBANON IN 46052
CHECK NUMBER: 195109
CHECK DATE: 3/2/2011
DEPARTMENT A CCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 127780 2,122.16 AUTO REPAIR MAINTEN
Feb 16 11 09;46a P,1
L,ESAMC>N T a FZa AUTO S vc
1310 W SOUTH STREET TiRfASXRVICE
LEBANON, I N 46052
rv�zuro+ux
(765)482 -5027
FEDERAL TAX ID# 351145753 6000`'
=1\BVO�CE
02/16/11 02/16/11 (�O-- DuArLew
27780
0 9:11 M I{
AM 08:17 AM
7;99- 017276 127780 TERR: 7798
PAGE: 0 1 ATCNSIG: 173531
BILL TO: CARMEL FIRE DEPT
BOB VANVOORST
2 CIVIC SQUARE
CARMEL, IN 46032
PHO E 1....... (317)664 -0958 EXT. VEH YEAR /MAKE.
PHONE 2......- (317)571 -2515 EXT. 7AX VEHICLE MODEL.
DATE REQUESTED 02/16/1 VEHICLE COLOR,
TIME REQUESTED LICENSE /STATE.
RETURN PARTS.. NO ODOMETR IN /OUT NA
SALESMAN...... 002 002 GS /AN IrumBER G0000733
PRIOR INVOICE. 126818
OTHER INFO.... UNIT #41 DRIVE TIRES
ACCOUNT CO3 TC CUST## TYPE /STATE A'JTHURIZATION
779800259 2 R 00259 4 IN VANVORS
SLSV TECH RODUCT CODE 8C 4TY D- SNIPTION PARTS LBR /EXCIS= -INE TOTAL
002 138 -864 -665 -0 G 4 128225 H 6238 MSA TL abh.66 .00 1866.64
OT 4 NO. MC3X88HR4410
,02 117 041 263 R 4 NEW VALVE STEM 4.50 .00 18.00
.,C2 01 093-002 R d TI P.= DISPOSAL 00 6.00 24AC
2C2 017 0 -150 R 4 MIS•- T4'K TIRE SVC 00 30.00 12C, 3C
002 017 046 -120 R ROAD SERVICE PER HR /PER MAN (REG TINE) .00 75.00 7`•.
REMEMBER TO S[RVTC= YOUR TRANSMISSION EVERY 150010 TO 30000 MILES' WE THANK YOL FOR "CUR BUSINESS WITH US.
PARTS TOTAL....... 1284.64
LABOR TOTAL. 219.00
CHARGED AMOUNT 2122. MISC S40P SUPPLIFS. 17.52
STATE TIRE FE'= 1.03 SUB TOTAL........ 2121.16
x--------------------------- TAXABLE AMOUNT a� A LS TA cS .00
CU5TO��ER AUTHORIZATIOY FOR TOTAL ]C NL/C7 Z C E TOT 1
AL_
3U1'ING PLAN.._ A OF FA VRFS. 1 PAY START DATE 03!19/11 DISCOUNT... *NET*
S SW ^I:iNX"c;S^ =WAF2RA�TY iMA� i��ETY
HAVE A QUESTION OR PROBLEM7
Piease Ieo our sLc re —nea er. We -1— your C O i*- as much as yo ur
business. Shauld you need adcunonal assistance, ca41 our
CUSTOMER ASSISTANCE UNE 1 -800- 321 -2136
VOUCHER NO. WARRANT NO.
ALLOWED 20
Lebanon Tire
IN SUM OF
1310 West South Street
Lebanon, IN 46052
$2,122.16
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 I 127780 I 43- 510.00 I $2,122.16 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
FEB 2 8 2011
i
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))
127780 $2,122.16
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