173759 08/24/2009 ^z f CITY OF CARMEL, INDIANA VENDOR: 00352688 Page 1 of 1
ONE CIVIC SQUARE CARQUEST AUTO PARTS STORES
0 CHECK AMOUNT: $367.19
,o CARMEL, INDIANA 46032 PO BOX 593601
ST LOUIS MO 63150 -3601 CHECK NUMBER: 173759
CHECK DATE: 6/2412009
DEPARTMENT ACCO P O NUM INVO N UMBER AMOUNT DESCRIPTION
TY2201 4238900 2601 -60553 367.19 OTHER MAINT SUPPLIES
PROUDLY SERVING A WORLD IN MOTIONS"
�A� Ae,ESt CQ OF NOBLESVILLE IN 9186 PAGE 1 OF 1
164 N 10TH ST REF# 93087
NOBLESVILLE, IN 46060
317 773 4274
AUTO PARTS WE WELCOME YOUR COMMENTS!
11111111 11111 IIIIII 111111111$ III II III II 111 �I III I CONTACT DEPARTMENT VOICE OF THE
CUSTOMER DEPARTMENT 877 735 -2233
21200905300260100000605530000093087733
ANY PRODUCT RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT. SEE CARQUEST STORE FOR DETAILS OF THE COAST TO COAST GUARANTEE.
BCITY OF CARMEL STREET DEPARTMENT HCITY OF CARMEL STREET DEPARTMENT
L3400 W 131ST ST 1 3400 W 131ST ST
L P
T WESTFIELD, IN 46074 T WESTFIELD, IN 46074
0 0
CUSTOMER SALES TEAMMATE
INVOICE NO. NO DATE COST. P.O. NO. ID ID FORM OF PYMT.
2601 -60553 860097 05/30/09 STATUE SR1230 CHARGE
MFG. PART NUMBER ORDERED SHIPPED LIST PRICE NET NET CORE EXT. AMOUNT TAX
1 DPC KM -8 2 2 123.37 74.02 0.00 148.04 IN
CHROMABASE COLOR
2 DPC K -8 2 2 82.92 49.75 0.00 99.50 IN
CHROMABASE COLOR
3 DPC 830,' -4 1 1 BC 182.83 109.70 0.00 109.70 IN
o HS FAST GREEN SPECIAL ORDER (BO)
w 4 NSN 481 -15 -01 1 1 B 16.58 9.95 0.00 9.95 /N
C' NASON SELECT THINNER SPECI ORDER (BO)
WARRANTY DISCLAIMER: "The factory warranty constitutes all of th w rra nties with respect to the sale of all items. The seller hereby expressly disclaims all warranties, either expressed or implied, including any
implied warranty of merchantabllity or Fitness for a particular purpose, the seller neither assumes nor authorizes any other person to assume for it any liability in connection with the sale of all items."
SHIP VIA DELV. TIME DELV. ID ITAXABLE AMT. SALES TAX TOTAL CORE PREY. DEPOSIT
0.00 0.00
RECEIVED PAY THIS
04:03 PM BY X CUSTOMER COPY AMOUNT
CARQUEST AUTO PARTS STORES REMIT TO:
PO BOX 503601 CARQUEST
ST LOUIS MO 63150 3601 419". STATEMENT CARQUEST AUTO PARTS STORES
UNITED STATES PO BOX 503601
(888) 340 -5043 AUTO PARTS ST LOUIS MO 63150 -3601
UNITED STATES
(888) 340 -5043
g®
POSP28004000851000505
IIJIIIIIIItIIILJIiIII�IIIIIIIIIIJIIIJII ,I�IIILIIIIIIIIII N �vs
CITY OF CARMEL STREET DEPARTMENT
3400 W 131 ST ST
W ESTFIELD IN 46074 Increase your efficiency by going online today
IJIIIJIIIILIJ: IJ�II�II�IIII ,IIIIIIIIII�IIIII www.CARQUEST.com /statements
Sign Up TODAY!
See back panel for details
CUSTOMER NO
PAY THIS AMOUNT IND 860097
CUSTOMER NO INTERNALCUST# STATEMENTDATE PAGE 3, 243.74 INTERNALCUST# STATEMENT DATE PAGE
CHECK
IND 860097 1141889 31- May -09 1 of 1 1141889 31- May -09 1 Of 1 ITEMS
NOT
INVOICE DATE INVOICE NUMBER PO NUMBER DUE DATE INVOICE AMOUNT AMOUNT PAID AMOUNT DUE INVOICE REFERENCE AMOUNT DUE PAID
01 -MAY -09 2601 -ID -59435 STATUE 30- JUN -09 1,687.15 1,687.15 2601 -ID -59435 1,687.15
11 -MAY -09 2601 -IC -59756 STATUE 30- JUN -09 1,687.15 1,687.15 2601 -IC -59756 1,687.15
11- MAY -09 2601 -IC -59803 STATUE 30- JUN -09 234.10 234.10 2601 -IC -59803 234.10
11- MAY -09 2601 -ID -59799 STATUE 30- JUN -09 2,876.93 2,876.93 2601 -ID -59799 2,876.93
11- MAY -09 2601 -10-59805 STATUE 30- JUN -09 12.28 12.28 2601 -ID -59805 12.28
13- MAY -09 2601 -ID -59863 STATUE 30- JUN -09 110.29 110.29 2601 -ID -59863 110.29
18- MAY -09 2601 -10-60044 STATUE 30- JUN -09 61.40 61.40 2601 -ID -60044 61.40
20- MAY -09 2601 -ID -60126 30- JUN -09 49.75 49.75 2601 -10-60126 49.75
30- MAY -09 2601-ID-60553 STATUE 30-JUN-09 367.19 367.19 2601 -ID -60553 367.19
IND Noblesville I 3,243.74 IND Noblesville IN 4
TOTAL 3, 243.741 PAY THIS AMOUNT
3,243.74
PAYMENTSUMMARY
DATE CHECKS PAYMENT
PAID PREVIOUS PAID CURRENT UNAPPUED =SUBTOTAL PAID FUTURE TOTAL PMTS
0.00 0.00 0.00 0.00 0.00 0.00
30 DAYS PAST 60 DAYS PAST 90 DAYS PAST 120 DAYS TOTAL PAST DUE
0.00 0.00 0.00 0.00 0.00
PREV. TOTAL DUE FINANCE CHG CURRENT -PAYMENTS TOTAL DUE FUTURE -TOTAL OWING
0.00 0.00 3,243.74 0.00 3,243.74 0.00 3,243.74
A FINANCE CHARGE OF 1.50 PERCENT PER MONTH (18.00 PERCENT PER YEAR)
WILL BE ADDED TO ACCOUNTS OVER 30 DAYS PAST DUE (0.50 MINIMUM)
OSP28 004 E00085- 1000505 0011003
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))
05/30/09 2601 -60553 $367.19
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
VOUCHER N O, WA NO.
ALLOWED 20
Carquest Auto Parts Stores
IN SUM OF
P. O. Box 503601
St. Louis, MO 63150 3601
$367.19
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member
2201 2601 -60553 42- 389.00 $367.19 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
I q Thu s ay, 18, 200
k l lil l
r
Street Commissioner/
Y
Gtrept C r3��rter
Cost distribution ledger classification if
claim paid motor vehicle highway fund