180860 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 363740 Page 1 of 1
ONE CIVIC SQUARE JAGGERS CHECK AMOUNT: $83.87
CARMEL, INDIANA 46032 1920 N LEBANON STREET
o� LEBANON IN 46052 CHECK NUMBER: 180860
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4351000 14600 83.87 AUTO REPAIR MAINTEN
1920 North Lebanon St.
JACYGFRS Q LEBANON, INDIANA 46052
{Z Phone (765) 482 -3515 Indpls. (800) 524 -4377
Parts Fax (765) 482 -2732
www.shopjaggers.com
TAX EXEMPT NUMBER"I CUST.P. I SHIP VIA PAY SOLD BY INVOICE DATE I INVOICE NO
69043 0031201550020 GARY CHARGE ANITA LAFOLLETTE 11/13/09 14600
317- 571 -2448 BUR
B S
I T H T
�ITY OF CARMEL P
CIVIC S UAR
CARMEL, I 46632
SHIP JB O Q TYj
PART NUMBER I DESCRIPTION BIN LIST
1 0 9597163 CAP 5.858 SPORD 111.83 83.87 $3.87 PARTS DEPARTMENT PM
M THURSO 8 :00 A
TUES MOO 5: 00
-THURS :00 M 00 PM
O �Gtl SAT -8:00 AM -1:00 PM
4
tig5� DISCLAIMER OF WARRANTIES
00 O� WARRANTIES ON THE ITEMIITEMS ARE THOSE
"0
V MANUFACTURER. M ADE
SELLER, JAGGERS q G
CH
0 J�{i�a BUCK. PONT AC. GMC TRUCKS.
C}Q HEREBY EXPRESSLY DISCLAIMS
ALL WARRANTIES, EITHER EX-
PRESS OR IMPLIED, INCLUDING
ANY IMPLIED WARRANTY OF MER-
CHANTABILITY OR FITNESS FOR A
PARTICULAR PURPOSE, AND
p p 7 JAGGERS CHEVROL91 BUICK,
NOTE: ELECTRICAL SPECIAL ORDER PARTS ARE NOT RETURNABLE!! SUBTOTAL 83, 8 PON IAC, GMC TRUCKS NEITHER
Al0% HANDLING CHARGE WILL BE ADDED ON ALL RETURNED PARTS. ASSUMES NOR AUTHORIZES ANY
ALL CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS BILL. NO REFUNDS AFTER 30 DAYS. OTHER PERSON TO ASSUME FOR
PARTS RETURN POLICY TAX 0.00 rr ANY LIABILITY IN CONNECTION
ALL RETURNED PARTS MUST CONFORM TO THE GM PARTS PACKAGING QUALITY STANDARDS, THOSE WITH THE SALE OF THIS
STANDARDS SHOWN UPON REQUEST.
FREIGHT 0.00 rrEMIrrEMS.
RECEIVED BY:k I PAY THIS AMOUNT 83.87
CUSTOMER COPY
11:57:13 PAGE 1 OF t
N ET504
PARTS INVOICE
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))
11/13/09 14600 BUR $83.87
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 NO. WARRANT NO.
ALLOWED 20
Jaggers
IN SUM OF
1920 North Lebanon Street
Lebanon, IN 46052
$83.87
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# I Dept. INVOICE NO_ I ACCT# /TITLE AMOUNT Board Members
1205 14600 BUR I 43- 510.00 I $83.87 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
Tuesday, December 22, 2009
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund