156689 02/21/2008 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE AUTO SVC
CARMEL, INDIANA 46032 1310 W SOUTH ST CHECK AMOUNT: $1,528.68
ti,, LEBANON IN 46052 CHECK NUMBER: 156689
CHECK DATE: 2/21/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 103484 1,528.68 AUTO REPAIR MAINTEN
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ACCOUNT COB TC CUST# TYPEISTATE
77600165 4 01 00168 3 IN
SL3M TECH PRODUCT CODE BC 9 TY DESCRIPTION PARTS LBR.iEXCI.SE LINE TOTAL
1�6-564- 6 4 12 R c 2 5 H F5 1 2 4 r
002 1 TL 32 Al 0 12E
GS NUMiER, G073f! CITY. 4 NO. mcdxcbHRI�80
Ois 1 R 4 NEi VALVE STEM 4.50 .00 15.1)0
002 Oi,8 V 0-,-�
,z R 4 TIRE DISPOSAL 00 0.00. 24.
002 018 040-14i R 5 MTiDiShT 17.3" RIM DIAM LGR OUTSIDE 00 25.00 125.00
002 018 046-120 R I ROAD SERVICE PER HRIPER MAN (REG TIME) .00 75.00 15.0
U C 7 NE
REMEMBER TO SERVICE YOUR TRANSMISSION EVERY 15006 TO 30000 MILES! WE THANK YOU FOR YOUR v I1 Sc WITH Us.
PARTS TOTAL 13fij-6wo
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�ARGED AMOUNT 1528.68 LABOR TOTAL H4.00
STATE TIRE FEE 1.00 SUE TOTAL 1527,65
TAXABLE AMOUNT .01) SALES TAX— .01)
CUSTOMER AUTHORIZATION FOR TOTAL 1 If.. 47 T 4 7 i--. i2 AL 1
Eb•iNG PLAN... A 0 fjF PAYMENTS. 1 PAY START DATE 02ifl0ifiS DISCOUNT...... iNETi
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Please t911 oupst6ref e Valu y our pinion aglti .�F OUF
business. Should you need additional assists
CUSTOMER ASSISTANC
1-800-321-2V
FORM GBMS-027 04/02
Qr Maintenance Yes No VIN
Review Work order Inspection
Record vehicle information Engine Size 2WD 4WD
Tire Flotation Yes No
Install interior protection Trans Type Auto Man.
Test drive (if applicable) Good Recommend
Review maintenance schedule Inspect Wipers ABS Frt Rear F N/A
and tire fitment Inspect Headlights A/C P/S A/P
Perform inspection indicated
Inspect Bulbs
Record findings /review history Inspect Air Filter(s) Tire Registration #'s (NEW TIRES)
Make recommendations per MAP Inspect Belts Inspect Hoses QTY Registration
Uniform Inspection Guidelines F-1 Inspect
Test Battery 1
Return w/o to appropriate individual Inspect Tires 2
Perform service requested Inspect Wheel Bearing
Test drive if applicable) El 3
Tes
pp Looseness
Exterior Condition Notes: Inspect Shocks 0 4
Struts Drum Rotor Specifications
Inspect Suspension LF RF RR LR
Inspect Exhaust
PSI Inspect Brakes Spec.
32ND IN OUT CONDITION Fluids Good Add Recom. Actual
LF Washer(s)
RF Power Steering Battery Load Test
RR Coolant/Anti- Freeze Spec.
LR Differential
SP Transmission Actual
Brake-
SIZE Oil Assoc.
TYPE Signature
Tech Qty Description Comments Map Service
Categories
1 2 3 4
f o
f
n d
Map Service Categories
Parts System Failure Service /replacement is required now Improved System Performance Service /replacement is suggested
2 Preventative Maintenance Service /replacement is suggested M Diagnostic Procedures Determines condition
performance of parts system Service is suggested
7
FORM GBMS -027 04102
's
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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))
d
9
i
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Pp# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 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
0
Signature
Cost distribution ledger classification if r Title
claim paid motor vehicle highway fund