176961 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 363306 Page 1 of 1
ONE CIVIC SQUARE TRIPLE S OF INDY INC
io CARMEL INDIANA 46032 836 S 22ND STREET CHECK AMOUNT: $314.88
"ti,�ron.�o r ELWOOD YN 46036 CHECK NUMBER: 176961
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 6925 314.88 TIRES TUBES
r
r�
Printed: 812712,009 9:30:37 AM
Stored IN INVOICE Sales Receipt #6925
ti
8/26/2009
Cashier: Chris
Page 1
Copy
TRIPLE S TIRE INDIANAPOLIS
836 S. 22ND ST.
ELWOOD, IN 46036
(765) 552 -5765
FAX: (765) 552 -5761
REMIT PAYMENT ABOVE
�3ill To: CITY OF CARMEL
CITY OF CARMEL,
3400 WEST 131 ST
WEST FIELD, IN 46074
Description 1 Descri 2 PI Y S ize Qty Price Ext Price
SERVICE CALL TRAVEL AND HOURLY FEES 1 $150.00 $150.00
Labor retail Mt/DisMt, Repair,On/Off, Inspect 1 $75.00 $75.00
SEALER SEALER PER GALLON 3 $29.96 $89.88 T
Subtotal: $314.88
Exempt 0 Tax: +$0.00
Ship 8/19/2009 511819 Shipping:
RECEIPT TOTAL: $314.88
Account: $314.88
Signature
Previous Account Balance: $0.00
EQ: JD544G
RR
HRS: 5208
SWO# 511819
PLEASE PAY FROM THIS INVOICE SALES RECEIPT. TERMS NET 30
WITH BILLING QUESTIONS CALL 765 -552 -5765 THANK YOU
1 111111 IIIII 11111 IIIII IIIII 1111 IIII
6925
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 f
Date Number (or note attached invoice(s) or bill(s))
08/26/09 6925 $314.88
1 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
VO UCHER NO. WARRA NO.
Triple S. of Indy, Inc. ALLOWED 20
IN SUM OF
836 S. 22nd St.
Elwood, IN 46036
$314.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# 1 Dept. INVOICE NO. ACCT91TITLE AMOUNT
Board Members
2201 6925 42- 320.00 $314.88 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
Fr' August 28, 2009
3
Street Co!414tsioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund