212962 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
Q � F ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $85.25
CARMEL, INDIANA 46032 Po sox 195
FISHERS IN 46038 CHECK NUMBER: 212962
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00129575 85 . 25 EQUIPMENT REPAIRS & M
126TH & REYNOLDS ROAD (HWY 37 NO.) FAST! Service at your Farm,
P.O. BOX 195
FISHERS, INDIANA 46038 Commercial Site or on the Road.
TIRE FISHERS 317-842-0544 OR 1-800-444-5985 All Major Brands Available
Fax 317-577-3956
/'—NAME/ADDRESS ACCOUNT NO. "'-'•' HOME PHONE REFERENCE NO.
EtROOKSl i :t ry;. : r: t317) 571-2427 I N001`9575
BROOKSHIRE GOLF CLUB
12120 BROOKSHI RE PARKWAY O.NO. 4 '°_T'±7�„;': t: WORK PHONE DATE/TIME
''' 09/19/12
12:49
RESALE NO. •4je�;i, r,1�v�, VIN NO. WO-ES NO.
CARMEL, IN 46033 W000086561
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 DATE TIME EMPLOYEE PHONE CUSTOMER
ORIGINAL ❑ FREE ROTATION
REVISED t (EVERY 5,000 MILES)
REVISED 2
1 acknowledge notice and oral approval of an increase in the original estimate price. El ROAD HAZARD WARRANTY
X
PARTS & OTHERS .� , M_. LABOR
DESCRIPTION EACH
1 CA510981 CAR 18-958-8/4 SMOOTHY 85.00 85.00 1.00 INDIANA TIRE FEE 0.25
I
Reason for original estimate;
Any warranties on the item/items 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
purpose,and CLARK TIRtr 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 t%%PER MONTH(21%ANNUALLY)WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS.NET 10th PROX.
TOTALS
I THE UNDERSIGNED HEREBY AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE AND IF THIS ACCOUNT IS PLACED IN 't 7) IIL
SHE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL.CHARGE EQUAL TO THE COST OF PARTS
COLLECTION INCLUDING AGENCY AND ATTORNEY FEES AND COURT COSTS INCURREb AND PERMITTED BY LAW GOVERNING THESE TRANSACTIONS 0. 25
LABOR
1 hereby authorize the repai rk to be a falo !h ecess tem terials.You and your employees may operate vehicle for purposes of testing, OTHER
inspection,or delivery at tsk.An ex s ac ged on vehicle to secure the amount of repairs thereto.It is also understood that
you will not be held res sible for I da rt' cars i n case of fire,theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL 85. 25
TAX 0. 00
Rec'd By B 5. 25
TOTAL
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C.AMOUNT C.C.TYPE C.C.APPROVAL CODE ON ACCOUNT THANK
HANK
- —-— — YOU!
�I
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire Fishers
IN SUM OF$
P.O. Box 195
Fishers, IN 46038
$85.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT
Board Members
1207 I IN00129575 I 43-500.00 I $85.25 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, September 21, 2012
r
irector, BroodVre Golf 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))
09/19/12 IN00129575 Repair Parts $85.25
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