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HomeMy WebLinkAbout177369 09/15/2009 CITY OF CARMEL, INDIANA VENDOR: 00350983 Page 1 of 1 ONE CIVIC SQUARE R 8 T TIRE AUTO NOBLESVILLE CARMEL, INDIANA 46032 17016 CLOVER ROAD CHECK AMOUNT: $6, 709.89 •st�i. NOBLESVILLE IN 46060 CHECK NUMBER: 177369 `s CHECK DATE: 9/15/20D9 DEPARTMENT ACCOU PO N UMBER INV OICE NUMB AMOUNT DESCRIPTION 1120 4351000 098281 456.00 AU'T'O REPAIR MAINTEN 1110 4232000 21086 100359 6,236.52 TIRES 601 5023990. 100874 17.37 OTHER EXPENSES 09/10/2009 10:33 3177733139 RTTIRE PAGE 01 R T TIRE AU N0BLESN /XL- 17 0 X 6 CLOVER ROAD NOBLESVILLE, IN 46060 (317)773 -3130 F8DERAL TAX ID# 351145753 05/28/09 06/01/09 02:58 PM 04:36 PM 7617 015489 098281 TER1R: 7617 PAGE: 01 NONSIG: 197505 BILL TO: CARMEL FIRE DEPAPTMENT (EO9) nOB VAN VOORST 2 CIVIC SQUARE CARMEL, IN 46032 PHONE 1....... (317)664 -0958 EXT. VEH YEAR /MAKE. PHONE 2....... VEHICLE MODEL. DATE REQUESTED 05/28/09 VEHICLE COLOR. TIME REQUESTED LICENSE /STATE. RETURN PARTS.. NO ODOMETR IN /OUT 0'00000 000000 SALESMAN...... 005 005 PRIOR INVOICE. 097548 ACCOUNT COB TC CUST# TYPE /STATE 761701614 4 01 01614 3 IN SLSM TECH PRODUCT CODE BC _qTY DESCRIP TION PARTS LBR /EXCISE LINS TOTAL GG5 732 -354 -500 -0 G 8 P225160R16 97V S2 EAG RS -A VSURP% 56.75 .00 454,00 55 NUMBER, G0730929 QTY. 8 NO. MKXOBEER4505 THANK YOu FOR CHOOSING R &T TIRE AUTO NOBLESVILLE. FOR ALL YOUR TIRE AUTO SERVICE NEEDS STORE HOURS: MONDAY THROUGH FRIDAY 7 AM -6 PM; SATURDAY 7 AM PM: CLOSED ON SUNDAY *SHOP SUPPLY FEES COVER MISC MATERIALS USED IN SERVICING YOUR VEHICLE 7: 5e es c ok r-e- s o of b `1 r�>b Co jz_tn c-� R RC PARTS TOTAL, 454.00 CHARGED AMOUNT 456.00 LABOR TOTAL........ .00 STATE TIRE FEE 2.00 SUB TOTAL 454.00 TAXAU AMOUNT .00 SAL TAX.......... 00 CUSTOMER AUTHORIZATION FOR TOTAL I m V CD I C a +4D TA L 4. 5 Es 00 BUYING PLAN_ A OF PAYMENTS. 1 PAY START DATE 07/10/09 DISCOUNT...... *NET* Call:- Flow Did we Do Today? We Want Your Feedback! 1.866 402.3523 Tell us for a Chance to WIN a $500 Gas Card Enter Code: 1 See Official Rules in stores and at www.goodyeartires.com /gascard for details. 1539019750582817 No purchase necessary. Two winners per month. Must Call w 7 days. Void where prohibited. Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL E An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, 6y 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)) 098281 $456.00 I hereby certify that the attached invoice(s), or biH(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. WAR N ALLOWED 20 R T Tire Auto IN SUM OF 170 Clover Road Noblesville, IN 46060 $456.00 ON ACCOUNT OF -APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 1120 098281 43- 510.00 $456.00 I 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 SEP 1 4 71 OR Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund R T TgF2E AUTO NOBLESV =l__.UE 17016 CLOVER ROAD NOBLESVILLE, IN 4.6060 (3 17) 773 -3130 CPOOD ...,..AINFA FEDERAL TAX ID# 351145753 xNvo x c a 09/09/09 09/09/09 N 'L IDO 8 7� 09:13 AM 09:46 AM TERR: 7617 PAGE: Ol NONSIG: 197505 BILL TO: CARMEL WATER PLANT (E09) 3450 WEST 131ST ST WESTFIELD, IN 46074 -8267 PHONE 1....... (317)716 -3909 EXT. VEH YEAR /MAKE. PHONE 2....... (317)716 -3909 EXT. VEHICLE MODEL. DATE REQUESTED 09/09/09 VEHICLE COLOR. TIME REQUESTED WAIT LICENSE /STATE. RETURN PARTS.. NO ODOMETR IN /OUT NA SALESMAN...... 005 005 PRIOR INVOICE. 099106 ACCOUNT COB TC CUST# TYPE /STATE 761704158 4 01 04158 0 IN SLSM TECH PRODUCT CODE BC QTY DESCRIPTION PARTS LBR /EXCISE LINE TOTAL 005 028 040 -265 R 1 TIRE REPAIR /CARRY IN (PATCH PLUG REPAIR) .00 16.00 16.00 THANK YOU FOR CHOOSING R &T TIRE AUTO NOBLESVILLE FOR ALL YOUR TIRE AUTO SERVICE NEEDS STORE HOURS: MONDAY THROUGH FRIDAY 7 AM -6 PM: SATURDAY 7 AMA PM: CLOSED ON SUNDAY *SHOP SUPPLY FEES COVER MISC MATERIALS USED IN SERVICING YOUR VEHICLE R.F CE 1YE D BY Lxl DATE 1 10# ACC T ;fir'-" us E PARTS TOTAL........ .00 LABOR TOTAL........ 16.00 MISC SHOP SUPPLIES, 1.28 CHARGED AMOUNT 17.37 SUB TOTAL...- 17.28 X--------------------------- TAXABLE AMOUNT 1.28 SALES TAX.......... 09 CUSTOMER AUTHORIZATION FOR TOTAL N V O 2 C E T O T A L 1 1 7_ :3 BUYING PLAN... A OF PAYMENTS. 1 PAY START DATE 10/10/09 DISCOUNT...... *NET* Ca How Did We Do Today? We Want Your Feedback! 1.866.402.3523 Tell us for a chance to WIN a $500 Gas Card Enter Code: See Official Rules in stores and at mm.goodyeartires.com /gascard for details. 2529019750508147 No purchase necessary, Two winners per month. Must call within 7 days. Void where prohibited. HAVE A QUESTION OR PROBLEM? Please tell our store manager. We value your opinion as much as your business Should you need additional assistance, call our CUSTOMER ASSISTANCE LINE 1 -900- 321.2136 f SAFTE-TY WARN SERI INJURY MAY RESULT FROW Tire failure due to underinflation 1 overloading follow owner's manual or tire placard in vehicle. a Explosion of tire rim assembly due to Improper mounting only specially trained persons should mount tires. All custom wheel lug nuts must be re- torqued after 25 miles and checked periodically. GEMINI NATIONWIDE WARRANTY These warranties apply only to parts and labor shown on your invoice there may be other components in a system that are not covered. AIR CONDITIONING SERVICES EXHAUST COMPONENTS (EXCLUDING MUFFLERS {COOLING SYSTEM SERVICES STEERING AND SUSPENSION PARTS (EXCLUDING Pits: 12 months cr 12,000 mites, vvh!chever co-es first. DRIVE TRAIN COMPONENTS) fi r. 1'2'.. mQnf'rr, r 2,0`0' rrn'es, s-- 4hiclr ver eery €es `,r5t. F'rir'Pt;: 12 rr €oaiths cr 12 0 00 C,3 0 .nrles,. vOl AIR SHOCKS La or: 12 mctr ihs or 12.001 :r��ila;a, �n�d�it.ix;e €�r eonTes Crst. ALIGNMENT MACPHERSON STRUTS CARTRIDGES, SHOCKS AND BRAKE SERVICES (EXCLUDING OVERHAUL) ASSEMBLIES, ENGINE TUNE UP Parts: Standard: 12 morals ar 12,000 miles, vfrich8var came; first ?arts: 12 months or 12 ?000 Parts: :._HeLme: Life lrne to tyre original purchaser. Labor: 12 months or 12,000 milos, whiche-er comes, first. txabo 12 month-, or 12,000 r-!ile,, wh'che.ver c: ernes firs 7 MUFFLER BELTS AND MOSES (COOLING SYSTEM) Parts: Standartf: 12 months or 12,000 =nih�,.s, ,�ich rnr conks 5rsl Parts: Llfc;tim:; to the original srarchaser. Farts: Lifetime: tiifetin�e to Ctie crlginat pu: °chaser. Labor: 12 months or 12,000 miles, Ahichever comes figs Labor- 12 rnortih5 or 12,0,;;0 miles, whichever comes `first. ?RAKE OVERHAUL (BRAKES SHOES AND/OR DISC PADS WHEEL BALANCE ,AIJ70 TIRES ONLY) 1NARRANITED LIFETIME) S:a ndrard. 1:3 rocii fins or 12,0E1J mi les, s hk€ hevnr co mes first Paris: 24 nront "is or 24,0170 miles. vvh €chr ;ver cornes first. Ufetme: Lift: of the orbinal Tread Labcr: 2r. months ar 24.000 r­ rtes. which ever comes firs;, Life of tread warranty g for the life of the tread of the fire we baian_:Cl Brak: OvertaaUl: disc a dior drurn performed as a package includes: Not valid it tire is dismounted. Present 'his invoits for a free lire rci atbn and corgi uut it whur,i balance iii. o tc r:ad rt s €rfaco. PAOrS, r'3bi ild o€ r�;plactt hydraulic raIipa ry eve 6 r nr €t�ti or 6,000 mitts. urF >e aIs (if aqr: €ppod), as ncia *.ec hare7 ara. Vo )icles requir €ng moumire, ("'r derilo� lnlr)q of Unes €:t;a e to .gyp 'o' ;a! i�9 can :a x DFurn brake simes. resurface erns; r teov wheel cylinders, grease excluded.) ,r�rals {il €.t;i:ippeC associated harr;.•,°;,€rc. Any and all direr brake service or repair Is covered Under the "rake Service` varfanty. "ALL FARTS ARE NEW UNLESS OTHERWISE DESIGNATED. AUTON40TIVE REPAIRS AND PARTS. EXCLUDING TIRES, ARE WARRANTED FOR A MINIMUM OF 12 (r ON1"I i s OR 12,000 MILES. FOR COMPLETE IVIIARRANTY DETAILS, SEE THE SPECIFIC ''WARRANTY FOR TIRES AND THE SPECIFIC, "RArRRANTY FOR AUTOMOTIVE REPAIRS AND FARTS," WHO MAKES THIS WARRANTY This warranty is made and will be serviced by the Gemini outlet who perfort the repairs identified on the face of your repair invoice. This warranty will also be honored by any participating Gornini outlet, nationwide, if you require warranty service 2:5 or afore miles from the location where the original service was performed, This warranty extends, only to you, the original purchaser. and the motor vehicle identified on the Original ref air invoice. It applies only during warranty periods stated abovc t,Narranty authorization rnust be obtained from the Warranty Adniinistrator pr ior to any warranty repair Being performed. Phone 1 -800- 426 -0733. Warranty repair costs are covered Lip to the cost of the oricgirlal repair. This warranty does not apply to vehicles used commercially- Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER E CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 350983 R T Tire Auto Purchase Order No. 17016 Clover Rd. Terms Noblesville, IN 46060 Due Date 9/10/2009 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9110/2009 100874 $17.37 I hereby certify that the attached invoice(s), or bill(s) is (are) true and p correct and I have audited same in accordance with IC 5- 11- 10 -1.6 DateIcer VOUCHER 092968 WARRANT ALLOWED 350983 ��,I IN SUM OF R T Tire Auto 17016 Clover Rd.� t Noblesville, IN 46060 ;or Carmel Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 100874 01- 6500 -04 $17.37 Voucher Total $17.37 Cost distribution ledger classification if claim paid under vehicle highway fund 17016 CLOVER ROAD NOBLESVILLE, IN 46060 (317)773 -3130 V0®� FEDERAL TAX ID4 351145753 G� =NVU =CE 08/17/09 08/26/09 N 10 0:5!5 1 9 03:22 PM 03:10 PM 7617- 015831- 100359 TERR: 7617 PAGE: Ol NONSIG: 197505 BILL TO: CARMEL POLICE DEPARTMENT JASON OGLE 3 CIVIC SQUARE CARMEL, IN 46032 PHONE 1....... (317)733 -4600 EXT. VEH YEAR /MAKE. PHONE 2....... VEHICLE MODEL. DATE REQUESTED 08/17/09 VEHICLE COLOR. TIME REQUESTED DELI LICENSE /STATE. RETURN PARTS.. NO ODOMETR IN /OUT NA SALESMAN...... 005 005 PRIOR INVOICE. 099292 ACCOUNT COB TC CUST# TYPE /STATE 761705743 4 01 05743 3 IN SLSM TECH PRODUCT CODE BC QTY DESCRIPTION PARTS LBR /EXCISE LINE TOTAL 005 732 354 -500 -0 G 100 P225/60R16 97V S2 EAG RS -A VSBRPTL 56.75 .00 5675.00 GS NUMBER. G0730929 QTY. 0 N0, MKXOBEER3009 005 758- 496 -189 -0 G 4 P245/75R16 109T WRL SLTARMR SL OWL TL 133.88 .00 535.52 GS NUMBER. G0730929 QTY. 4 NO. MK703PHR2009 THANK YOU FOR CHOOSING R &T TIRE AUTO NOBLESVILLE FOR AL!. YOUR TIRE AUTO SERVICE NEEDS STORE HOURS: MONDAY THROUGH FRIDAY 7 AM -6 PH: SATURDAY 7 AM -4 PM: CLOSED ON SUNDAY *SHOP SUPPLY FEES COVER MISC MATERIALS USED IN SERVICING YOUR VEHICLE PARTS TOTAL........ 6210.52 CHARGED AMOUNT 6236.52 LABOR TOTAL........ .00 STATE TIRE FEE 26.00 SUB TOTAL.......... 6210.52 X--------------------------- TAXABLE AMOUNT 00 SALES TAX.......... .00 CUSTOMER AUTHORIZATION FOR TOTAL X N V® I C E T O T A L. 4 Z:3 45 5 z BUYING PLAN... A OF PAYMENTS. 1 PAY START DATE 09/10/09 DISCOUNT...... *NET* Call: How Did We Do Today? We Want Your Feedback! 1.866.402.3523 Tell us for a chance to WIN a $500 Gas Card Enter Code: See Official Rules in stores and at www.goodyeartires.com /gascard for details. 2389019/50503598 No purchase necessary Two winners per month. Must call within 7 da s. Void where prohibited. HAVE A QUESTION OR PROBLEM? Please tell our store manager. We value your opinion as much as your business. Should you need additional assistance, call our CUSTOMER ASSISTANCE LINE 1 -800- 321 -2136 C� S ERIOUS I.,"AFETY IWARNING INJURY MAY RESUL FROW Tire failure due to underinflation overloading follow owner's manual or tire placard in vehicle. Explosion of tire rim assembly due to improper mounting only specially trained persons Should mount tires. All custom wheel lug nuts must be re- torqued after 25 miles and checked periodically. GEMINI NATIONWIDE WARRANTY These warranties apply only to parts and labor shown on your invoice there may be other components in a system that are not covered. AIR CONDITIONING SERVICES EXHAUST COMPONENTS (EXCLUDING MUPF=LER) COOLING SYSTEM[ SERVICES STEERING AND SUSPENSION PARTS "EXCLUDING Parts: 12 �onttas c7r 12,000 miles, wl�ioP;ever comes first. DRIVE TRAIN COMPONENTS) l...whc; r: 12 mantris or 1 2,00C) n01�es, M comes (first. Parts: 12 c;r 12 ry le" com? first. Labor: 12 month, cr 12,000 whic,X vnr comas firs:. AIR SMOCKS ALIGNMENT MACPHERSON STRUTS -CARTRIDGES, SHOCKS AND DRAKE SERVICES (EXCLUDING OVERHAUL.) ASSEMBLIES, ENGINE TUNE UP Parts: Stan dard: 12 months car 12,0100 miies. wtaichever comes firs Paris: 12 months or 12,:00 miles, vrhichaver comes tl,wst. Parts: Lifetirme: Lift me to the origirrj pt,rctaaser. Labo ,2 rnonihs ar 12,000 relies, whir.. haver comes firs[. Labor 12 months or vahichever c:.,tnet first. MUFFLER BELTS AND HOSES (COOLING SYSTEM) Parts: Standard: 12 nir atths or 12 00 miles, vvhi^,Fever comes fir Paris: L fciirTi;r tr3 t1?r, c;riglnai puref,aser. Parts: Lifetlrne: ofietime to the original purchaser. Lanor: 12 months nr 12.000 1TAOs..zh!(,hover cornes fir; _abl )r, 12 months or 12,XW mires, first. BRACE OVERHAUL BRAKES SHOES ANDIOR DISC, PACE'S V11HEEL DAU.,,NC E AUTO TRES ONLY) WARRANTED LI FETIME) taridard: 12 rnunttas or 12,00 0 m0e.s, wtaichetfer comes firSt Part_ 2.4 ni,^,nihs or 24,000 rniles, whichever nog eF, first. Litz irne. Lift, of tha on nrii trt ad Lab 2,1 months or 24,000 Ifos, >vhtche.ver co her, first. Life or tread warranty good far .he the ttc;ad of the liras five bat anca. Brake Ove `l,wl: disc andior drum performed as to package includes: Not valid it ire 1,s dismoonted. Present ,vas invoice for a free tire rot!af on and cc mputer r hkP €i l t�, mama. every 6 rionths or 0 Disc -(Jisc pads. r srarfar e rotors, rebuild or re� plaf� e nydr n�ic, Calipc,r 0c milts. (Vehicles roquirrrttq mounting or of tics d,ua to sr3e r nI vrhoe'. "s crease seals (if cqg associated hardware, excluded.) a Drum -brake shoes, resurface drurns; new ,vlr i cyiinders, grease seals (fir equipped), associated hardvvare. Any arrd call other brake service or repair is covered under the "brake Service" war'r'anty. "All.. PARTS ARE NE%N UNLESS OTHERV DESIGNATED, AUTOKI-1 0TIVE REPA RS AND PAM'S, EXCLUDING TIRES, ARE 'AARRANTE'D FOR A NIINIIAUM OF 12 t ONT! iS OR 12.000 MILES. FCR COMPLETE IJVARRANFFY DETAILS, SEE THE SPECIFIC 'VIVARRANTY FOR 'FIRES AND THE SPECIFIC'," VARRANTY FOR AU'rok10TIVE REPAIRS AND FARTS." WHO MAKES THIS WARRANTY This warranty is made and will be serviced by the Gernini outlet who performed the repairs identified on the face of yotar repair invoice. This warranty will also be honored by any participating Gemini outlet, nationwide, if you require, warranty service 25 or more miles from the location where the original service was perforn ed. This warranty extends only to you. the original purchaser, and the Motor vehicle ids ritfied on the o.- iginal repair invoice. It applies only during warranty periods stated above. Warranty authorization must be obtained from the Warranty Administrator prior to any warranty repair being performed. Phone 1 -800- 426 -0733. Warranty repair costs are covered up to the coast of the original repair. This warranty sloes not apply to vehicles used commercially. Cl'ty INDIANA RETAIL TAX EXEMPT PAGE Carmel CERTIFICATE N 003120155 082 0 PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 9 3',©NE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL INDIANA 46032 -25$4 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SNIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Au st 19. 2009 tires VENDOR R T Tire and Auto SHIP City of Carmel Maintenance Fa 17016 Clover Road TO 3400 W. 131st Street Noblesville, IN 46060 Wesffield, IN 46074 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE XTENSION 100 tires 56.75 4 tires (garage truck) 133.88 535.52 Tj r�L' z7Lz Coo VIP tl A, a kj gyp* Send Invoice To: PLEASE INVOICE IN DUPLICATE I 6,210.52 DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1110 320 tires and tubes PAYMENT A!P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. fJ NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. A P C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �.fl'.t _i� SHIPPING LABELS. r THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2108 CLERK- TREASURER DOCUMENT CONTROL NO A.A. COPY SIGN AND RETURN TO CLERK'S OFFICE WOUCHER NO._ WARRANT NO. ALLOWED 20 IN THE 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 bili(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 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund Y Presced by State Board of ,Accourts 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 R T Tire and Auto Purchase Order No. 21086F 17016 Clover Road Terms Noblesville, IN 46060 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 8/17/09 100359 payment for tires 6,236.52 Total 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. WARRANT NO. ALLOWED 20 R T Tire and Auto IN SUM OF 170�6 Clover Road Noblesville, IN 6,236.52 ON ACCOUNT OF APPROPRIATION FOR p olice general fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 21086F 100359 20 6,236.52 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 September 4 20 09 Signature Chief of POlice Cost distribution ledger classification if Title claim paid motor vehicle highway fund