210930 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE&AUTO SVC
` CARMEL, INDIANA 46032 1310 W SOUTH ST CHECK AMOUNT: $9,250.53
`�. LEBANON IN 46052
„o a� CHECK NUMBER: 210930
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 L008HE 4, 509 . 64 AUTO REPAIR & MAINTEN
1120 4351000 L008QV 2 , 273 . 57 AUTO REPAIR & MAINTEN
1120 4351000 L008RU 2 , 467 .32 AUTO REPAIR & MAINTEN
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 06/19/12 04 :36 PM RePrint
1310 W. SOUTH STREET Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: L008HE L00259
Sold-To: Ship-To: Type - Payment
CARMEL FIRE DEPT $
2 CIVIC SQUARE $
CARMEL, IN 46032
Total $ 0.00
REP 317-664-0958
317-571-2615
!R! SCU;UNIT C;BOX 21, .59,3;RPU;EXIT;
Qty Shp B/0 Item Number Description S/W FET Price Amount Init' s
1 1 046120000 ROAD SERVICE PER HR/PER MAN (R 85. 00 85.00 222,220
8 8 GY138864665 12R225 H G288 MSA T 513 .33 4106.64 222
dot# MC3XL7OW0112, MC3XL7OW0112, MC3XL70W0112, MC3XL7OW0112
MC3XL7OW0112, MC3XL7OW0112, MC3XL7OW0112
8 8 EPA STATE TIRE FEE (INDIANA) 0.25 2 .00 222
8 8 041263000 NEW VALVE STEM 4 .50 36.00 222
8 8 046100000 MT- DISMOUNT 28.00 224 .00 222,220
1 1 047100000 UNIT-43-46 --4 EACH 0. 00 0.00 222,220
1 1 047100000 BOB VANVORST 0 .00 0.00 222,220
1 1 047100000 ENGINE 446 MILES 96577 0. 00 0.00 222,220
1 1 047100000 ENGINE #43 MILES 84296 0. 00 0 .00 222,220
8 8 093002000 TIRE DISPOSAL 7. 00 56.00 222,220
--------------------
V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$4509.64
IN GOV'T, 0.000%
$0.00
Total: $4509.64
NewPymt: $0.00
Total Due: $4509 . 64
Received By: SP:JEFF HOGG
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 06/28/12 04 :27 PM
1310 W. SOUTH STREET Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: L008QV UNIT 40 L00259 1 ST 10TH
Sold-To: Ship-To: Type - Payment
CARMEL FIRE DEPT $
2 CIVIC SQUARE $
CARMEL, IN 46032
Total $ 0.00
REP 317-664-0958
317-571-2615
!R! SCU;UNIT C;BOX 21,..59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
4 4 GY138864665 12R225 H G288 MSA T 513 .33 2053.32 202
dot# MC3XL70W0112, MC3XL70W0112, MC3XL70W0112, MC3XL70W0112
4 4 EPA STATE TIRE FEE (INDIANA) 0.25 1.00 202
4 4 041263000 NEW VALVE STEM 4 .50 18 .00 202
4 4 046100000 MT- DISMOUNT 28. 00 112 .00 202,220
1 1 OPP INNER BUDD NUT 4 .25 4 .25 202
UNIT #40
1 1 046120000 ROAD SERVICE PER HR/PER MAN (R 85. 00 85.00 202,220
--------------------
V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$2273.57
IN GOV'T, 0.000`s
$0.00
Total: $2273.57
NewPymt: $0. 00
Total Due: $2273 . 57
Received By: SP:Terry Millikan
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 06/28/12 04 :53 PM RePrint
1310 W. SOUTH STREET Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: L008RU UNIT UNIT 45 L00259
Sold-To: Ship-To: Type - Payment
CARMEL FIRE DEPT $
2 CIVIC SQUARE $
CARMEL, I_N 46032
Total $ 0.00
ARC 317-664-0958
317-571-2615
!R! SCU;UNIT C;BOX 21, .59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
4 4 GY138864665 12R225 H G288 MSA T 513 .33 2053 .32 JPK
dot# MC3XL7OW0112, MC3XL7OW0112, MC3XL7OW0112, MC3XL7OW0112
4 4 EPA STATE TIRE FEE (INDIANA) 0 .25 1. 00 JPK
4 4 041263000 NEW VALVE STEM 4 .50 18.00 JPK
4 4 093002000 TIRE DISPOSAL 7 .00 28. 00 JPK,220
4 4 040141000 MT/DISMT 17.5" RIM DIAM & LGR 28 .00 112 .00 JPK,220
4 4 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 340.00 JPK,220
UNIT 45
-1 -1 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 -85.00 JPK,220
--------------------
V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$2467.32
IN GOV'T, 0.000%
$0.00
Total: $2467.32
NewPymt: $0.00
Total Due: $2467 . 32
Received By: SP:Jim Kitchel
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))
L008RU E45 $2,467.32
L008HE E43, E46 $4,509.64
L008QV I E40 I $2,273.57
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
Lebanon Tire
IN SUM OF $
1310 West South Street
Lebanon, IN 46052
$9,250.53
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 L008RU 43-510.00 $2,467.32 1 hereby certify that the attached invoice(s), or
1120 L008HE 43-510.00 $4,509.64 bill(s) is (are) true and correct and that the
1120 I L008QV I 43-510.00 I $2,273.57 materials or services itemized thereon for
which charge is made were ordered and
received except
JUL 16 202
<
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund