208280 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 00351179 Page 1 of 1
ONE CIVIC SQUARE FIRESTONE TIRE SERVICE CENTER CHECK AMOUNT: $35.49
ra CARMEL, INDIANA 46032 Po Box 403727
ATLANTA GA 30384 -3727 CHECK NUMBER: 208280
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4351000 121977 35.49 AUTO REPAIR MAINTEN
Page I of I
Customer Invoice FIRESTONE COMPLETE AUTO CARE Service Advisor:
121977 1314 S RANGE LINE RD Sabrina Ford
3/29/2012 CARMEL, IN 46032 (317)848 -5886
Duplicate Invoice
2008 Ford Escape Hybrid
City Of Cannel. Building Code 4 -140 2.3L DOHC
One Civic Square Lic 74792 IN Vin
Carmel, In 46032 In: 3/2912012 10:23:00 AM Mileage: 37945
(317)509 -8239 Out: 3129/2012 4:35:32 PM
Store# 20753 COMMERCIAL Reg#
Description Article T# CITY Unit Extended Job
Number Price Price Total
SYNTHETIC BLEND OIL CHANGE UP TO b 35.49
4.5 QTS. 0 0 0 0.00 0.00
SAE 5W -20 Premium Synthetic Blend M 0 0 0 0.00 0.00
The Manufacturer recommends an Oil 0 0 0 0.00 0.00
OIL FILTER 7005781 195 1 3.99 3.99
5W20 SYNTHETIC BLEND UP f0 5 QTS 7023809 195 1 21.50 21.50
USED OIL FILTER RECYCLING CHG (1) 7075051 195 1 2.50 2.50
OIL CHANGE LABOR 7029718 195 1 7.50 7.50
COURTESY CHECK 000
COURTESY CHECK 7046930 195 1 0.00 0.00
Technicians):
BENEFIEL, RYAN
Payment History:
Charge Tendered 35.49
Summary:
Remit to: Firestone, P.O. Box 403727, Atlanta, GA 30384 -3727 Parts 25.49
Labor 10.00
THANK YOU Shop Supp. 0.00
Sub -Total 35.49
Tax (7 -00 0.00
Total 35.49
hhite
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))
03/29/12 121977 Oil Change $35.49
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. W NO.
ALLOWED 20
Firestone Complete Auto Care
IN SUM OF
P.O. Box 403727
Atlanta, GA 30384
$35.49
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO# Dept. INVOICE NO. I ACCT #/TITLE AMOUNT Board Members
1192 121977 43- 510.00 $35.49
I I I 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
Thursday, pril 19 20122
Dir
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund