173102 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 353827 Page 1 of 1
ONE CIVIC SQUARE ZIEBART OF INDIANAPOLIS
CARMEL, INDIANA 46032 6155 E 86TH ST CHECK AMOUNT: $1,268.98
INDIANAPOLIS IN 46250
CHECK NUMBER: 173102
CHECK DATE: 5/27/2009
DEPARTMENT ACCOUNT PO NUM BER I NVOICE NU MBER AMOUNT DESCRIPTION
1120 4351000 342832 1,268.98 AUTO REPAIR MAINTEN
CUSTOMER COPY INVOICE
.I
Date Order
05/13/09 342832
Auto- x -10'd, Inc. /IN37
6155 E 86th St. Suite C
Sales ID: RG
Indianapolis, IN 46250
Phone #:317- 577 -9192 Fax #:317- 841 -0426
CUSTOMER OF:
C Carmel Fire Dept None
U 10701 N. College Ave
s
T Carmel, IN 46032 Phone None
0 Customer Phone 3178183400
M
E
R
CUSTOMER TYPE. Retail BRANCH CUST. AR# CARMEL
P.O. CAR4509 FLEET MASTER BILLING NO. BATCH
DELIVER TO:
MFGR ODOMETER
VEHICLE I.D. SERIAL NO. 9EA85476 UNIT STOCK NO. DATE READING
YEAR 2009 MAKE, MODEL COLOR FORD F -250
Qty. Description Part Warranty Amount
RL RHINO LINER *RHINO LINER CARS004376 299.99
UC UNDERCOATING *UNDERCOAT 99.99
TC UNDERCOVER *TONNEAU COV 750.00
SG SPLASH GUARDS *SPLASH GDS 99.00
Z1 Environmental Impact Surcharge *EPA COMP 20.00
1,268.98
ASK ABOUT OF 50TH ANNIVERSARY SPECIALS
SUBTOTAL 1,26
Sales Tax —eS3
CAR4509 Total
CASH ON ACCOUNT CHECK BANKCARD REM CARD
1,357.81 D
F IHIR EBY AUTHORIZE THE WORK SHOWN TO BE DONE ALONG WITH THE NECESSARY MATERIALS AND AGREE THAT YOU ARE NOT RESPONSIBLE
OR DAMAGE TO VEHICLE OR ARTICLES LEFT IN CASE OF FIRE, THEFT OR ANY OTHER CAUSE BEYOND YOUR CONTROL. AN EXPRESS NICS LIEN IS HEREBY ACKNOWLEDGED ON THE ABOVE VEHICLE TO SECURE THE AMOUNT OF SERVICE HERETO.
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))
342832 $1,268.98
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
Ziebart
IN SUM OF
6155 E. 86th Street #C
Indianapolis, IN 46250
$1,268.98
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 342832 43- 510.00 $1,268.98 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
MAY 2 2 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund