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Home My WebLink About207415 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