209516 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE FISHERS
CARMEL, INDIANA 46032 Po Box 195
CHECK AMOUNT: $440.00
FISHERS IN 46038 CHECK NUMBER: 209516
CHECK DATE: 6/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00127316 440.00 EQUIPMENT REPAIRS M
126TH REYNOLDS ROAD (HWY 37 NO.) i
FASTS Service at
P.O. BOX 195 your Farm,
FISHERS, INDIANA 460381 t av1�)r Commercial Site or on the Road.
317- 842 -0544 OR 1- 800 444
TIRE FISHERS Fax 317-577-3956 All Major Brands Available
NAME ADDRESS ACCOUNT NO. HOME'.PHONE REFERENCE NO.
FIROOI:SH (x;17) 571- 2, IN00:12 731
BROOKSHIRE GOLF CLUB
P.O. NO. WORK PHONE DATE TIME
1 BRODKSHI RE PARKWAY (:317) 12)5/25/1 12:5
CARI�EL, IN 46833 RESALE NO. VIN NO. WI�O��� 84988
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 WS
ESTIMATE AMOUNT DA TE TIME EMPLOYEE PHONE CUSTOMER
ORIGINAL FREE ROTATION
REVISED 1 (EVERY 5,000 MILES)
REVISED 2
1 acknowledge notice and oral approval of an increase in the original estimate price. ROAD HAZARD WARRANTY
X
PARTS OTHERS r, LABOR
DESCRIPTION EACH DESCRIPTION
2 558454 29X12.58 -15/6 TURF C/S 219.75 439.58 2.88 INDIANA TIRE FEE 8.58
Reason for original estimate:
Any warranties on the item/items sold hereby are those made by the manufacturer. The seller, CLARK TIRE,hereby expressly
My all warranties either express or implied, including any implied warranty of merchantability or fitness for a particular
of this ItemftCLARK TIRE neither assumes nor authorizes any other person to assume for It any liability m connection with the sale
A SERVICE CHARGE OF 1%% PER MONTH (21% ANNUALLY) WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS. NET 10th PROX.
WT THE UNDERSIGNED HEREBY AGREE THAT IN TH EVENT DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE, AND IF THIS ACCOUNT IS PLACED IN "r +-l'G
HANDS OF AN AGENCY OR ATTORNEY T' OLLE ION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF PARTS
COLLECTION INCLUDING AGENCY AND A OR FEES D COU COSTS INCURREb AND PERMITTED BY LAW GOVERNING THESE TRANSACTIONS ltl„ J ``7�r
�Lt
LABOR
I hereby authorize the rep ork to on to wi ess aterials. You and your employees may operate vehicle for purposes of testing, OTHER
inspection, or delivery a t isk. An es mech.n' acknowledged on vehicle to secure the amount of repairs thereto. It is also understood that
you will not be held re sible for or a s articles left in cars in case of fire, theft or any other cause beyond your control. SUBLET
440. 00
Signature X SUBTOTAL 0.00
TAX 440. OL
Recd By TOTAL
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C. AMOUNT C.C. TYPE C.C. APPROVAL CODE ON AC40 4417 ��11
N O THANK
YOUI
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire Fishers
IN SUM OF
P.O. Box 195
Fishers, IN 46038
$440.00
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1207 I IN00127316 I 43- 500.00 I $440.00 I 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, June 01, 2012
Director, Brooksh j ifkGolf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
05/25/12 I IN00127316 I Repair Parts I $440.00
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