207778 04/10/2012 VENDOR: 00352688 Pa e 1 of 1
CITY OF CARMEL, INDIANA g
ONE CIVIC SQUARE CARQUEST NOBLESVILLE
CARMEL, INDIANA 46032 PO BOX 503589 CHECK AMOUNT: $196.69
ST LOUIS MO 63150 -3589 CHECK NUMBER: 207778
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 2738 176885 196.69 REPAIR PARTS
Great people, great products, great prices!
0
CAR U T CQ OF IND -BASH RD IN 9146 PAGE 1 OF 1
8357 BASH STREET REF# 290714
INDIANAPOLIS, IN 46250
317 849 -6300
AUTO PARTS REMIT TO: CARQUEST AUTO PARTS
III IIIIIIIIIiIIIIII II�IIIIIII OIIIIIIIIIIIOIIIIIIIIIIII 6 PO BOX 53589
ST LOUIS, MO 63150 -3589
21201204040273800001768850000290714406
ANY PRODUCT RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT. SEE CARQUEST STORE FOR DETAILS OF THE COAST TO COAST GUARANTEE.
BCITY OF CARMEL STREET DEPARTMENT HCITY OF CARMEL STREET DEPARTMENT
X3400 W 131ST ST P3400 W 131ST ST
T WESTFIELD, IN 46074 T WESTFIELD, IN 46074
0 0
CUSTOMER SALES TEAMMATE
INVOICE NO. NO DATE CUST. P.O. NO. ID ID FORM OF PYMT.
2738 176885 860097 04/04/12 TRUCK NUMBER 53 RR1290 CHARGE
MFG. PART NUMBER ORDERED SHIPPED LIST PRICE NET NET CORE EXT. AMOUNT TAX
1 LTG 53630 1 1 B0 176.49 95.19 0.00 95.19 IN
STT P RED SPECITL ORDE BO)
2 LTG 53640 1 1 B0 176.49 95.19 0.00 95.19 IN
STT LAMP RED SPECIAL ORDER BO
FRT FREIGHT 1 1 6.31 0.00 6.31 IN
FREIGHT
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a
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WARRANTY DISCLAIMER: The manufacturer's warranty, if any, constitutes the only warranty with respect to the sale of all goods. SELLER HEREBY EXPRESSELY DISCLAIMS ALL WARRANTIES, EITHER EXPRESSED
OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Seller does not authorize any person to grant any warranty or assume any liability by Seller.
SHIP VIA DELV. TIME DELV. ID FREIGHT TAXABLE AMT. SALES TAX I TOTAL CORE PREV. DEPOSIT
6.31 0.00 0.00
RECEIVED PAY THIS
10:41 AM BY X CUSTOMER COPY AMOUNT 196.69
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))
04/04/12 2738 176885 $196.69
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Carquest Auto Parts Stores
IN SUM OF
P. O. Box 503589
St. Louis, MO 63150 -3589
$196.69
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
2201 I 2738 176885 I 42- 370.001 $196.69 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
r ridgy,' April 06, 2012
treet Commissi y r
Street CoTmEnissioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund