200821 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE FISHERS
0 iI CHECK AMOUNT: $301.00
CARMEL, INDIANA 46032 Po sox iss
FISHERS IN 46038 CHECK NUMBER: 200821
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00122489 301.00 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 -0544 OR 1- 800 444 -5985 All Major Brands Available
Fax 317- 577 -3956
NAME ADDRESS ACCOUNT NO. HOME PHONE 'REFERENCE NO..
BROOK"' (s 17) 571--2-4 I N00122489
BROOKSHIRE GOLF CLUB P.O. NO. WORK PHONE DATE TIME
12120 BROOKSHIRE PARKWAY t 3171 08/12"111 11.02
RESALE NO. VIN NO. WO ES NO.
CARMEL, IN 46033 W000081 510
YEAR MAKE MODEL LICENSE NO. TAG NO. NEXT INSP. DATE BAR NO.
SAVE PARTS ALL PARTS NEW UNLESS PROMISED DATE TIME MILEAGE WHITTEN BY
Y N OTHERWISE SPECIFIED �,Ic
AM OUNT ESTIMATE DATE TIME EMPLOYEE CUSTO
ORIGINAL FREE ROTATION
REVISED 1 (EVERY 5,000 MILES)
REVISED 2
I acknowledge notice and oral approval of an increase in the original estimate price. F1 ROAD HAZARD WARRANTY
X
PARTS OTHERS LABOR
DESCRIPTION EACH DESCRIPTION
4 511257 20X12.00 -10/4 TURFt1ASTER 75,00 308.00 4.00 INDIANA TIRE FEE 1.80
Reason for original estimate:
Any warranties on the iterMtems sold hereby are those made by the manufacturer. The seller, CLARK TfRE,hereby expressly
disclaims all warranties either express or implied, including any implied warranty of merchantability or fitness for a particular
purse, and CLARK TIRE neither assumes nor authorizes any other person to assume for it any liability In connection with the sale
of the itemrtems.
A SERVICE CHARGE OF 1;4% PER MONTH (21% ANNUALLY) WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS- NET 10th PROX.
I THE UNDERSIGNED HEREBY AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE AND IF THIS ACCOUNT IS PLACED IN PART
,7,
1 hereby authori
COLLECTION INCLUDING AGENCY AND ATTORN EE AND IO URT OR LEGAL ACTION TO PAY AN COSTS INCURRED AND PERMITTED 13Y GOVERNING THESE SACTIONS 300 Q 710
LABOR 1 00
ze the repa ork to bone ortg w' the cessary materials. You and your employees may operate vehicle for purposes of testing OTHER
inspection, or delivery at risk. An a fes mechani. s lie Wledged on vehicle to secure the amount of repairs thereto. It is also understood that
you will not beheld res Bible for la amage t oar articles left in cars in case of fire, theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL 301. 00
TAX
0. 00
Rec By TOTAL 301 00
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C. AMOUNT C C TYPE t I,% C.C. APPROVAL CODE ON ACCOUNT THANK
j 381.00 YOU!
V NO. WARRANT NO.
ALLOWED 20
Clark Tire Fishers
IN SUM OF
P.O. Box 195
Fishers, IN 46038
$301.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 IN00122489 43- 500.00 $301.00 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
Monday, August 22, 2011
Director, Brooks ire Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 199'.
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))
08/12/11 IN00122489 Repair Parts $301.0
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