207415 03/26/2012 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
Q� ONE CIVIC SQUARE CLARK TIRE FISHERS
®'a CARMEL, INDIANA 46032 PO BOX 195 CHECK AMOUNT: $67.25
9 MOM FISHERS IN 46038 CHECK NUMBER: 207415
CHECK DATE: 3/2612012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00125979 67.25 EQUIPMENT REPAIRS M
126TH REYNOLDS ROAD (HWY 37 NO.)
P.O. BOX 195 FAST! Service at your Farm,
FISHERS, INDIANA 46038 Commercial Site or on the Road.
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.
Tr f1t]OKSH (3517) 571- I N001259 7 9
BROOKSHIRE GOLF CLUB P.O. NO. WORK PHONE DATE /TIME
12120 BROOKSHI RE PARKWAY ,1 7 03/161/12 12 E
RESALE NO. VIN NO. WO ES NO.
CAME, IN 46033 W00008400
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 RS
ESTIMATE AMOUNT DATE TIME EMPLOYEE PHONE CUSTOMER
ORIGINAL El FREE ROTATION
REVISED I (EVERY 5,000 MILES)
REVISED 2
I acknowledge notice and oral approval of an increase in the original estimate price. ROAD HAZARD WARRANTY
X
PARTS OTHERS k LABOR
OTY. PART NO. DESCRIPTION EACH DESCRIPTION goo
1 CA510981 CAR 18- 950 -8/4 SMOOTHY 62.00 62.00 1.00 INDIANA TIRE FEE 0,25
1.00 DISMOUNT MOUNT 5.00
Date- Init.
Account LA 6 5 v o
Account
Account
Account
Reason for original estivate:
Any warranties on the itemAtems sold hereby are those made by the manufacturer. The seller, CLARK TIRE,hereby expressly
disclaims all warranties 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
oft his iterrititems.
A SERVICE CHARGE OF 1Y.% PER MONTH (21% ANNUALLY) WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS. NET 10th PROX.
TOTALS
1 y THE UNDERSIGNED HEREBY AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE AND IF THIS ACCOUNT IS PLACED IN PARTS
IHE HANDS OF AN AAGENCY OR AT JOLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING A ENCY A ES A D COURT COSTS INCURREb AND PERMITTED BY LAW GOVERNING THESE TRANSACTIONS e J LABOR I hereby authorize the r air wor b necessary materials. You and your employees may operate vehicle for purposes of testing, OTHER
inspection, or delive my risk en is acknowledged on vehicle to secure the amount of repairs thereto. It is also understood that you will not be held sponsible- r 1 s or articles left in cars in case of fire, theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL G 25
TAX 12). OL71
Rec'd By TorAL E
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C. AMOUNT C.C. TYPE C.C. APPROVAL CODE ON ACCOUNT THANK
67.25
YOU!
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))
03/16/12 I IN00125979 I Repair Parts I $67.25
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
Clark Tire Fishers
IN SUM OF
P.O. Box 195
Fishers, IN 46038
$67.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1207 I IN00125979 I 43- 500.00 I $67.25 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
Friday, March 23, 2012
Director, Brookshir Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund