211252 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $150.50
CARMEL, INDIANA 46032 PO BOX 195
FISHERS IN 46038 CHECK NUMBER: 211252
CHECK DATE: 7/3112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00128248 150 . 50 EQUIPMENT REPAIRS & M
126TH & REYNOLD,S,ROAD (HWY 37 NO.) FAST/ Service at our Farm,
0;,`.BOX 195 y
FISHER$'�I.NDIANA 46038 Commercial Site or on the Road.
TIRE FISHERS 317-84 2_05443:QR 1-800-444-5985
All Major Brands Available
Fz;i3:17 577 3956
'3
('NAME/ADDRESS ACCOUNT NO. HOME PHONE REFERENCE NO.
EAROOKSH (317) 571-2427 I N001 28248
BROOKSHIRE GOLF CLUB P.O.NO. WORKPHONE DATE/TIME
12120 BROOKSHIRE PARKWAY (.31 7) 07/1-3/12 1 ;05
RESALE NO. VIN NO. WO-ES NO.
CAWL, IN 46033 W000085647
YEAR/MAKE/MODEL LICENSE NO. TAG NO. NEXT INSP.DATE BAR NO.
SAVE PARTS ALL PARTS NEW UNLESS PROMISED DATE/TIME MILEAGE WRITTEN BY W
Y N OTHERWISE SPECIFIED
L ❑ FREE ROTATION
(EVERY 5,000 MILES)
dge notice and oral approval of an increase in the original estimate price. ❑ ROAD HAZARD WARRANTY
PARTS & OTHERS v.- . • LABOR
EXTENSION DESCRIPTION EA DESCRIPTION
2 519472 18.5/8.5-8/6 USA TRAIL 75.00 150.00 2.00 INDIANA TIRE FEE 0.50
I
Date �� `� _ init.
Account# � 'o $
Account #
Account#
.,.Account,#
Reason for original estimate:
Any warranties on the itemlitems sold hereby are those made by the manufacturer.The seller,CLARK TIRE,hereby expressly
disclaims all warranties either express or implied,including any implied warranty of merchantability or fitness for a particular
putpose,and CLARK TIRE neither assumes nor authorizes any other person to assume for it any liability in connection with the sale
of this item items.
A SERVICE CHARGE OF 1%1%PER MONTH(21%ANNUALLY)W IL E CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS.NET 10th PROX. TOTALS
I THE UNDERSIGNED HEREBY AGREE AT IN T EVENT O DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE AND IF THIS ACCOUNT IS PLACED IN
SHE HANDS OF AN AGENCY RAT RNEY F R COLLIE ION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF PARTS
COLLECTION INCLUDING AG CY A ATTO Y FEES A RT COSTS INCURREb AND PERMITTED BY LAW GOVERNING THESE TRANSACTIONS LABOR 0. 50
1 hereby authorize the re �i work be necessary materials.You and your employees may operate vehicle for purposes of testing, OTHER
inspection,or delivery y risk. mecha n is ac hicle4e-j ure the amount of repairs thereto.It is also understood that
you will not be held r onsible f as da o s or articles left in cars in case of fire,theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL 150. 50
TAX Q7I, 00
Rec'd By 1510.. 50
TOTAL
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C.AMOUNT C.C.TYPE C.C.APPROVAL CODE ON ACCOUNT- THANK
150.50
YOU!
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire Fishers
IN SUM OF $
P.O. Box 195
Fishers, IN 46038
$150.50
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I IN00128248 I 43-500.00 I $150.50 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
Friday, July 27, 2012
Director, Brookshire bolf 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))
07/13/12 IN00128248 Repair Parts $150.50
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