HomeMy WebLinkAbout202278 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 00350983 Page 1 of 1
ONE CIVIC SQUARE R T TIRE AUTO NOBLESVILLE CHECK AMOUNT: $4,893.75
s ��a CARMEL, INDIANA 46032 17016 CLOVER ROAD
NOBLESVILLE IN 46060 CHECK NUMBER: 202278
CHECK DATE: 9/2712011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4232000 27896 N0026H 4,893.75 TIRES
09/22/2011 11:28 3177733139 RTTIRE PAGE 01
R T irx N oblesville R+.: &.rL5�1t1ki(]�.��feS��S?.ei3363d
Store Location store Phn Date Time
R T Tire /Auto NOP (317) 773 -3130 08/18/11 11:24 AM
17 016 CLOVER RD Re Print
1
NOBLESVILLE, IN 46060
Your P/O A/R Acct# Terme Ship Via
Inv: N0026H JASON N05743 1 ST 10TH
Sold -To: Ship -TO: Type payment
CARMEL, POLICE DEPARTMENT
3 CIVIC SQUARE
CARMEL, IN 46032
Total 0.00
.ARC 317- 733 -4600
atc;: •ii
Qty Shp H/0 Itart► Number Description 'qrST Price Amount Init'a
75 75 GY732354500 PO 5/60R16 97V S2 EAC+ l,; 65.00 4875.00 5
75 75 EPA E TI RE FEE (INDIANA) 0.25 18.75 5
c, aa113{ lel,
11
V /Info: i` 1111 1 I a Irillnr I`11
8llb
hi�.y I•, I I' I irw-I'�la u $4893
I.
IN GOVIT,0.000§
$0.00
Total: $4893.75
9, +I k X t $0.00
a
Total Due: 4893.75
Received By: SP:Chuck Godby
INDIANA RETAIL TAX EXEMPT PAGE
City o f Ca' CERTIFICATE N0.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972 MEW
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
FARM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. F VENDOR NO. k DESCRIPTION
RA T Tim an Auto Cwmal Police DGpaldmoat
VENDOR SHIP
TO 3 Clbic squam
MIS Clovor Romd Ca mol, Ili
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-32040
75 Each t i res $55.00 $4,875.00
Sub Total: $4,875.00
Vim.
Send Invoice To:
Cum al Police Departmont
Attn: Tova$m An ds mon
a Clvlc squ
PLEASE INVOICE IN DUPLICATE
C
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Po lice Dept. PAYMEN PP
A/P VOUCH CANNOT BE APPROVED FOR PAYMENT LR .O.
Carmel h!� NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION Uff ICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE i _o
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 27896 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# 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_
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
R T Tire and Auto
IN SUM OF
17016 Clover Road
Noblesville, IN 46060
$4,893.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
27896 I N0026H I 42- 320.00 I $4,89375 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
Friday, September 23, 2011
Chief of Police
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))
08/18/11 N0026H payment for tires $4,893.75
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