206639 02/28/2012 1. CITY OF CARMEN, INDIANA VENDOR: 00351640 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE FISHERS
CHECK AMOUNT: $144.25
s. r CARMEL, INDIANA 46032 PO BOX 195
FISHERS IN 46038 CHECK NUMBER: 206639
CHECK DATE: 212812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00125484 144.25 EQUIPMENT REPAIRS M
126TH REYNOLDS ROAD (HWY 37 NO.) FAST! Service at our Farm,
P.O. BOX 195 Commercial Site or on the Road.
FISHERS, INDIANA 46038
TIRE FISHERS 317- 842 -0544 OR 1 -800-444-5985 All Major Brands Available
Fax 317 577 -3956
NAME ADDRESS ACCOUNT NO. HOME PHONE REFERENCE NO.
BI?I)OKSH (_1:1.7) 571 ;R lp;_ IN00125484
BRMKSHIRE GOLF CLUB P.O. NO. WORK PHONE DATE /TIME
12IN BROOKSHIRE PARKWAY .317) 0i''.! 1 1,2 r.:? 4.
RESALE NO. VIN NO. WO ES NO.
CARMEL, IN 46033 w0e,thIZ 8:3 9.3
YEAR MAKE MODEL LICENSE NO. TAG NO. NEXT INSP. DATE BAR NO.
SAVE PARTS ALL PARTS NEW UNLESS PROMISED DATE /TIME MILEAGE WRITTEN BY
Y N OTHERWISE SPECIFIED T G
ESTIMATE AMOUNT D ATE
ORIGINAL F1 FREE ROTATION
REVISED 1 (EVERY 5,000 MILES)
REVISED 2
I acknowledge notice and oral approval of an increase in the original estimate price. El ROAD HAZARD WARRANTY
X
PARTS OTHERS LABOR
DESCRIPTION EACH DESCRIPTION
1 574377 26X12 -12.16 NIJL.TITRAC CIS 140.00 148.80 1.00 INDIANA TIRE FEE 0.25
1.00 TIRE DISPn. L PAS. 4.00
t 4
A "--count
Account
Account
l
Reason for original estimate:
Any warranties on the item /items sold hereby are those made by the manufacturer. The seller, CLARK TIRE,hereby expressly
disclaims all warrantles either express or implied, including any implied warranTy of merchantability or fitness for a particular
purpose, and CLARK TIRE neither assumes nor authorizes any other person to assume for it any liability in connection with the sale
of this itemAtems.
A SERVICE CHARGE OF 1 PER MONTH (21% ANNUALLY WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS. NET 10th PROX. TO TALS
I W THE UNDERSIGNED HEREBY AGREE THAT I�1 HE pp�F D AULT I'�y HE PAYMENT OF ANY AMOUNT DUE AND IF THIS ACCOUNT IS PLACED IN pgRTS 11
E HANDS OF AN AGENCY OR ATTORNEY OR�COLL,ECTIO OR L GAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF.
COLLECTION INCLUDING AGENCY AND ATT N FEE 'AND URT C TS INCURREb AND PERMITTED BYLAW GOVERNING THESE TRANSACTIONS LABOR ,Cl, e 25
1 hereby authorize the repo rk to be d a1�n ith the cess mate rYcu and your employees may operate vehicle for purposes of testing, OTHER
inspection, or delivery at isk. An ex r mecp nic's Ile s e god on vehicle to secure the amount of repairs thereto. It is also understood that
you will not be held resp Bible for lo� ar" to Cdr I e left in cars in case of fire, theft or any other cause beyond your control. SUBLET
Si nature X SUBTOTAL 4,4.
g TAX 1 7 1 00
Rec'd B 14 ie•. 25
By —TOTAL
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C. AMOUNT G.C- TYPE C.C. APPROVAL CODE ON ACCOUNT THANK
144.25 HORN
VOUCHER NO. WARRANT NO,
ALLOWED 20
Clark Tire Fishers
IN SUM OF
P.O. Box 195
Fishers, IN 46038
$144.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Goff Club
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1207 IN00125484 43- 500.00 $144.25 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
Monday, February 20, 2012
Director, Brookshir Club
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))
02/13/12 IN00125484 Repair Parts $144.25
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