180077 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 362828 Page 1 of 1
ONE CIVIC SQUARE GENERAL PARTS LLC CHECK AMOUNT: $250.25
CARMEL, INDIANA 46032 Milo
PO BOX 9201
CHECK NUMBER: 180077
MINNEAPOLIS MN 55480 -9201
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 5200282 250.25 EQUIPMENT REPAIRS M
r
INVOICE: 5200282
Invoice Date 11/30/2009
g pa its Service Order 684731
6546 CORPORATE DRIVE Customer PO
INDIANAPOLIS, IN 46278 ..To 3
Bi11 2836°
317 -290 -8060 FAX 317 -290 -8085 BROOKSHIRE GOLF CLUB
800- 410 -9794 FAX 877 715 -1373 12120BROOKSHIRE PKWY
CARMEL, IN 46033
Phone:(317) 846 -7431
Mail To,: 32836,. Serviced. "A't /,Sh�� "ed`To i 32836 4
BROOKSHIRE GOLF CLUB BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY 12120 BROOKSHIRE PKWY
CARMEL, IN 46033 CARMEL, IN 46033
Phone :(317)846 -7431 Phone:(317) 846 -7431
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Make S' I:No
228452 JACKSON DISH WASHER AVENGER HT 08L245142
wo''rkJ!erforrn6d f'
11/24/9 -UPON ARRIVAL AND INSPECTION, THE UNIT WAS OFF AND EMPTY. THE WATER WAS TURNED
OFF AND THE POWER. THE 2 UNIONS WERE UNSCREWED AND THE UNIT WAS DRAINED. THE FILL
SOLENOID WAS TAKEN APART FOR INSPECTION OF PLUNGER. FOUND NO VISIBLE DEBRIS, BUT WHEN
I BLEW AIR THROUGH DIAPHRAM, SAND PARTICLES CAME OUT. SOLENOID VALVE WAS RINSED AND
REASSEMBLED AND MANIFOLD WAS REINSTALLED. THE WATER WAS TURNED ON TO CHECK FOR
LEAKS. ALL UNIONS WERE TIGHT. A LEAK WAS PRESENT ONRIGHT SIDE ABOVE CHEMICAL PUMPS.
BOTH NUTS WERE TIGHTENED APPROX 3/4 TURN. UNIT MEETS OEM SPECS.
Repair Requested by: BOB HIGGANS
Repair Approved and Inspected by: PAM LISTER
Labor 191.25
Service Call Charge 59.00
Total 250.25
4
Paid 0.00
Balance Due 250.25
NET 10 DAYS
Form 60
*REMIT MIT TO: GENERAL PARTS LLC MI10 PO BOX 9201 M- INNEA.POLIS -MN 554980 79201
o Authorized Service and Parts for Foodservice Equipment
Refr and HVA CF&S4 Cert
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
f
(j Purchase Order No.
1
Terms
�/2 i) .1S 9, Q Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
W,�2 sa
Total 0��6, 2S_
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
VOUCHER NO. _1A(,ARRANT NO.
I
ALLOWED 20
IN 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
�20'7 S5 a00".g coo -o aw „�S 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
Vj
Si ature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund