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Home My WebLink About180529 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 363395 Page 1 of 1 *f ONE CIVIC SQUARE SOUTHSIDE HARLEY CHECK AMOUNT: $249.20 CARMEL, INDIANA 46032 4930 SOUTHPORT CROSSING PLACE INDIANAPOLIS IN 46237 CHECK NUMBER: 180529 CHECK DATE: 12/1612009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4232000 21213 970479 249.20 TIRE DEC -10 -2009 15:30 FROM:INDPLS SOUTHSIDE H -D 3178855193 TO:913175712512 P:1/1 ••v.vwu�n�r nrivi rayc, 12:22PM INDIANAPOLIS SOUTHSIDE H•D 4930 SOUTHPORT CROSSING PLACE INDIANAPOLIS, IN 46237 II (317) 68a -5180 Customer: 66877 W,O. Number 65072 CITY OF CARMEL Appointment: 9/24/2009 1 :20PM Mileage In: 5228 3 CIVIC SQUARE Offered Back: 9124109 129PM Mileage Out: 5230 Year: 2007 Shop Tag: CARMEL. IN 48032 Mfg: HO Plate No; Phone: 'Work: (317)571 -2559 Ext: Model: FLHP Service Advisor. CB Fax: (317)5712512 Mobile: VIN; IHDiFHM187Y677893 Sold By: CB P,O. No; Tax No: Tax Exempt: Yes Color: BIRCH WHITE Invoice No; 970479 Comments; Ref. No.: Dlr. Lic Item Number Item Description 1 Delivered Price Each l Extended Job Coda Labor Description Quantity! Hours Hourly Rate Amount Event Number: 1 Type: R Description: R &R REAR TIRE 43329 -04 0402 MU85B16 BW 1.00 169.95 169.95 LABOR Job Code: 0 Tech: RLR 1.00 75.00 75.00 Sub -total For Event (without Tax 244.95 Charged On Account: 249.20 Item Total: 169.95 SOrLayaway Deposit; 0.00 Labor Total: 75.00 Work Order DepoSt 0.00 Contract Labor: 0.00 Shop Supplies: 2.25 Total Deductible(s): 0,00 Storage Fee; 0,00 Tax/Fee Charges: 2,00 Total Amount: 248.20 Total Received 0.00 Change Tendered: 0,00 INDIANA RETAIL TAX EXEMPT PAGE C ity of C armel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 1 3 CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION S enteoAber 2009 tire VENDOR SoutEside Marley SHIP City of Carmel Police Department 4930 Southport Crossing Place To 3 Civic Square Indianapolis, IN 46237 Cammel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 1 motorcycle tire dor cycle 128 Driver 235.00 Send Invoice To: City of Carmel Polk _e ar ATTN: Teresa. Anderso 3 Civic S4unae Carmdl, IN 46032 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT T PROJECT f PROJECT ACCOUNT AMOUNT 1110 320 tires and tubes PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND 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. r C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY L uLC(.�l l;•r�l.�i. w SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99 ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 �OCUMENT CONTROL NO. A ;.v. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER 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 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 20 l Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund a Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 ,Indianapolis Southside Harley— Davidson Purchase Order No. 21213F 4930 Southport Crossing Place Terms Indianapolis, IN 46237 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9/24/09 970479 pyament for tire for motorcycle 128 249.20 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 I i�� 's 5outhside Harley— Davidson IN SUM OF 4930 SOuthport Crossing Place Indianapolis, IN 46237 249.20 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 21213F 970479 20 249.20 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 December 10 20 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund