179104 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 00350714 Page 1 of 1
ONE CIVIC SQUARE AIRWORX CORP CHECK AMOUNT: $337.31
CARMEL, INDIANA 46032 BOX 7842 RELIABLE PARKWAY
CHICAGO IL 60686 -0078 CHECK NUMBER: 179104
CHECK DATE: 11/11/2009
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
_1120 4350900 210393 337.31 OTHER CONT SERVICES
11/05/2009 THU 8:40 FAX 2002 /003
Page I
G0i7StrYVt10n V?701P/naAt a Suppl
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501 W. RAYMOND ST.
INDIANAPOLIS, IN 46225 d.
mj
317 -471 -1272
CARMFI, FIRE DEPT
WORK ORDER INVOICE
2 CTVTC SQUARE:
ATTN RICK MARPIN
CARMEL, IN 460 ^32 Ir�r�].C�� �!�.0393 9001
Cu. s tonl
ex 113 2',
Job Lod 540 W J:35TH ST�'.EET, GA
Job S1te S40' 13 5THTRE' A CAMEL' ,Tob No 2 CARMEL FIRE DEPT
CARMEL FIRE DEPT p'O
540 W 136TH ST R EET thora zed JIM DAVIS
ATTN JIM DAUIS
CARi�7EL IN 4 6 0;3 2
Recei�rcd aril 10/0809
Fin h�d an; 1021 f 09
71 5;90 326
Last con cis 1132;
qu ke Model
S ex�?X D scrs33.
E z Nda
0900019144JLG 25AM 0900019144 CUSTOMER OWNED EQUIP
Work Order Description:
INTERMITANT OUTRIGGER CONNECTION PROBS
LABOR DESCRIPTION:
Troubleshot. Found that 3 outriggers are in need of rebuilding on contact strip
for safety's- order parts from shop. Returned, installed parts for outrigger s
nsors. Tested operat. pnq, all ok.
PARTS:
Qty Part Ntitltl5er e Extended
ELECT KCAL SYSTEMS
8 0902;288 WASI EA x.000 8.00
4 390b193;C'Rl EA .850 3.40
A6.2
1 4740434 WASHER j(�`� 100) EA 910 .91
1 FUEL CHARGE 2 FUEL CHARGE 2 EA 40.000 40.00
A8.3
1 FRT FREIGHT CHARGES (PAR EA 5.000 5.00
A8.3
Section Total: 57.31
CONTINUED..,
'ATTN: CUSTOMER IS TO CALL EQUIPMENT OFF RENT AND I ACQUIRE A TER I M I NATION NUMBER.
Dexter nerees,to waive carteln damages and logs claims against Customer, which are provided for on the reverse elde of this contract, in consideration of :he following: A. Customer shall pay a fee of
10% of gross rontai charges. B. A valid certificate of insurance is provided Dealer prior to the hire of equipment, whereby Dealer Is named an additlonal insured on an insurance policy, covering tha risk
of loss by damage. death or otherwise, of tha subject equipment, end said insurance being primary coverage as against any other insurance which may be provided by Dealer.
DAMAGE WAIVER DECLINED
I HAVE READ AND I AGREE TL) THE CONTRACT TERMS ON THE BACK OF THIS DOCUMENT, THOSE TERMS CONSIST OF OUR ENTIRE AGREEMENT. NO ONE HAS ANY ORAL OR OTHER
WRITTEN REPRESENTATIONS OR PROMISES NOT INCLUDED IN THIS CONTRACT. I HERESY ACKNOW4EOGE RECEIPT OF A COPY OF THIS CONTRACT.
CUSTOMER SIGNATURE DATE NAME PRINTED DELIVERED BY DATE
Fs
YOU ARE CHARGED FOR THE TIME EQUIPMENT IS IN YOUR POSSESSION, NOT TIME IT IS USED, AND CONDITION OF EQUIPMENT DESCRIBED ABOVE 18 IN GOOD WORKING ORDER.
11/05/2009 THU 8:41 FAX 10003/003
0 M Page 2
construction c•quiprnent 8 supply
33�
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501 W. RAYMOND ST.
INDIANAPOLIS, IN 46225
317 471 -1272
CARML FT DEPT. WORK ORDER IN`TOICE
2. CIVIC S
ATTN RICK MARTIN Invaic <f #0393 QOQ1
Date0: %2 /09
Cti.Stomr
Job Loo 54'0 W J 3 5TH> SIRE CA
:Jab site 540:, W 136TH STREET, CARNET;' Job No', 2 CARMEL :FIi E-.'.:DEPT:
CARMEL IX. E DEPT
540 V7 136iH STREET:
Authorized JIM DA�TIS
ATTN JZM DAMS
GARME
Rece> vec oz� 20/08 f Q.9
5.90 3426
9
Lastcon /pus io %21 /x: 1132;
Miter
Ecp Ma} �1a1e1 Sera al #3e�cx1ptlon
0900019144JLG 25AM 0900019144 CUSTOMER OWNED EQUIP
LABOR:
Mechanic Hours Work Rate Extended
230 2.50 ELECTRICAL SYSTEMS 80.00 200.00 g
230 1.00 ELECTRICAL SYSTEMS 80.00 80.00
f
Total Parts Materials 57.31
Total Labor 280.00
Toa1 Amount
337,32. d
iy
6JST OMERIS TO CALL EQUIPMENT
Dealer agrees to waive certain damages and loss claims against Customer, which are provided for on the reverse side of this contract, in con9iderr;tlon of the Iotlowing: A. Customer shall pay a fee of
10% of gross rental charges. B. A valid certificate of Insurance is provided Dealer prior to the hire of equipment, whereby Dealer is named an additional insured on an insurance policy, covering the risk
of Ines by damage, death or otherwise, of the subject equipment, and said insurance being primary coverage as against any other Insurance which may he provided by Dealer.
DAMAGE WAVER DECLINED
tiyV.
I HAVE READ AND I AGREE TO THE CONTRACT TERMS ON THE BACK OF THIS DOCUMENT. THOSE TERMS CONSIST OF OUR ENTIRE AGREEMENT, NO ONE HAS ANY ORAL OR OTHER RA'
WRITTEN REPRESENTATIONS OR PROMISES NOT INCLUDED IN THIS CONTRACT. I HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT.
CUSTOMER SIGNATURE DATE NAME PRINTED DELIVERED BY DATE
YOU ARE CHARGED FOR THE TIME EQUIPMENT IS IN YOUR POSSESSION, NOT TIME IT IS USED, AND CONDITION OF EQUIPMENT DESCRIBED ABOVE I$ IN GOOD WORKING ORDER,
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))
210393 $337.31
I 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
VOQCHER NO. WA RRANT NO.
A;,•Worx
ALLOWED 20
l
n) q T IN SUM OF
Box 7842 Reliable Parkway
Chicago, IL 60686 -0078
$337.31
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 210393 43- 509.00 $337.31 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
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund