HomeMy WebLinkAbout180529 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