210811 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350431 Page 1 of 1
ONE CIVIC SQUARE DICKINSON FLEET SERVICES, LLC
CARMEL, INDIANA 46032 16389 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $270.38
CHICAGO IL 60693 CHECK NUMBER: 210811
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 1814858 270 . 38 REPAIR PARTS
ia,a qty , Dickinson Fleet Services, LLC Invoice#1814858
16389 COLLECTIONS CENTER DRIVE Date 6/26/12
CHICAGO, IL 60693 Page : 1
Phone: 317.872.4542 Fax: 317.872.7624
Center : 4
INDIANAPOLIS, IN 317-872-4542 P.O.# :TRUCK 201
Customer: CARMEL STREET DEPT
Address : 3400 W 131 ST ST 1
City : WESTFIELD, IN 46074- �� I
Phone 1 : ( 317 ) 733-2001 Ext: Cd
Phone 2 : ( 317 ) 733-2005 Ext
Op Tech Description Time Labor Parts Subtotal
Qua n Part Number Part Description Reason for Replacement Price
MISCELLANEOUS PARTS 270.38 270.38
2.00 R801073 AUTO SLACK ADJUSTER 270.38
OK Bad Recommendation OK Bad Recommendation OK Bad Recommendation
PAYMENT TERMS: NET30 REMIT: 16389 COLLECTIONS CENTER DRIVE, CHICAGO, IL 60693 Labor: $0.00
CUSTOMER ACKNOWLEDGES THAT HE HAS INSPECTED THE REPAIRS TO THE VEHICLE ON THIS Parts : $270.38
INVOICE AND THE REPAIRS MEET THE CUSTOMERS REQUIREMENTS AND EXPECTATIONS. Sublet: $0.00
CUSTOMER FURTHER AGREES TO PAY THE INVOICE IN FULL, AS SHOWN, WITHOUT Other Fees : $0.00
DEDUCTION OR SET OFF. ANY WARRANTIES ON THE PARTS AND ACCESSORIES SOLD HEREBY Mis/Fuel/EPA $0.00
ARE MADE BY THE MANUFACTURER. DICKINSON FLEET SERVICES, LLC MAKES NO Subtotal : $270.38
WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, AND DISCLAIMS ALL WARRANTIES OF Sales Tax : $0.00
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, WITH REGARDS TO THE
SERVICE, PARTS, LABOR, AND/OR ACCESSORIES PURCHASED AND THAT IN NO EVENT SHALL Paid By Total : $270.38
DICKINSON FLEET SERVICES, LLC BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL On Account
DAMAGES O RCI LOS ISING OUT OF SUCH PURCHASES. Pay Ref: Paid : $0.00
X
� Due : $270.38
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))
06/26/12 1814858 $270.38
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
Dickinson Fleet Services
IN SUM OF $
16389 Collections Center Drive
Chicago, IL 60693
$270.38
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT _ Board Member;
2201 I 1814858 I 42-370.001 $270.38 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
Wednesda,y,�July s11, 2012
l Tel �• 6i11 f it`e,�,�k`/" ""
vv `�treet Commissioner
Street Coritwlssioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund