211245 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00352688 Page 1 of 1
` ONE CIVIC SQUARE CARQUEST AUTO PARTS STORE
€ CHECK AMOUNT: $428.75
CARMEL, INDIANA 46032 PO BOX 404875
ATLANTA GA 30384-4875 CHECK NUMBER: 211245
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236400 2601-97535 428 . 75 PAINT
Great people, great products, great prices!"
ORQUEST CQ OF NOBLESVILLE IN # 9186 PAGE 1 OF 1
164 N 10TH ST REF# 148187
go" NOBLESVILLE, IN 46060
317-773-4274
AUTO PARTS REMIT TO: CARQUEST AUTO PARTS
IIII� I Iltll Ifllll�l IIIIIIIII Ittl Illllllltllt I I IIIIIII PO BOX 404875
ATLANTA, GA 30384-4875
21201207120260100000975350000148187532
ANY PRODUCT RETURNED FOR CREDIT MUST BE ACCOMPANIED BY THIS RECEIPT. SEE CARQUEST STORE FOR DETAILS OF THE COAST TO COAST GUARANTEE.
,CITY OF CARMEL STREET DEPARTMENT ICITY OF CARMEL STREET DEPARTMENT
X3400 W 131ST ST 400 W 131ST ST
TWESTFIELD, IN 46074 VESTFIELD, IN 46074
0 0
CUSTOMER SALES TEAMMATE
INVOICE NO. NO DATE CUST. P.O. NO. ID ID FORM OF PYMT.
2601-97535 860097 07/12/12 61760 CHARGE
MFG.PART NUMBER ORDERED SHIPPED LIST PRICE NET NET CORE EXT.AMOUNT I TAX
1 DPC KH-8 5 5 85.26 62.15 0.00 310.75 /N
2 DPC 6155-4 1 1 86.72 63.30 0.00 63.30 EIN
0 3 DPC 616S-4 1 1 37.21 27.14 0.00 27.14 /N
a
W4 KS GWT50 2 2 18.31 13.78 0.00 27.56 /N
a
U
WARRANTY DISCLAIMER:The manufacturer's warranty,if any,constitutes the only warranty with respect to the sale of all goods.SELLER HEREBY EXPRESSELY DISCLAIMS ALL WARRANTIES,EITHER EXPRESSED
OR IMPLIED,INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.Seller does not authorize any person to grant any warranty or assume any liability by Seller.
SHIP VIA DELV.TIME DELV.ID FREIGHT TAXABLE AMT. SALES TAX TOTAL CORE PREY.DEPOSIT
0 .00 0 .00
RECEIVED PAY THIS
12 :27 PM BY x L CyY at5/ CUSTOMER COPY AMOUNT ® 428.75
—fV,sC,wl p- -irb 4- q2
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))
07/12/12 2601-97535 $428.75
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Carquest Auto Parts Stores
IN SUM OF$
P. O. Box 404875
Atlanta, GA 30384-4875
$428.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT
Board Members
2201 I 2601-97535 I 42-364.00j $428.75 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
a / Thursday July 26, 2012
Street Commissioner
v Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund