213146 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
ONE CIVIC SQUARE POMP'S TIRE
CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT CHECK AMOUNT: $2,383.00
PO BOX 1630
„o CHECK NUMBER: 213146
GREEN BAY WI 54305-1630
CHECK DATE: 9125/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 830004693 1, 049 . 52 TIRES & TUBES
2201 4232000 910003840 1, 333 .48 TIRES & TUBES
Sep, I M N:5 u PNI/V
ATTN:AR D1=PARTMENT
1; ,- , ..w.,,..,..,,���i :w9�,➢. I3.0. BOX 1630
9y`s�n%9nnnnacnm➢ican�m ➢➢491169➢9V GREEN BAY,WI 54305-1630
I
POMP'S TIRE—LEBANON INVOICE 4 : 830004693
1316 WEST SOUTH STREET
PAGE :
LEBANON, IN 46052
I
765/482-4359
CUSTOMER: CITY OF CARMEL STREET DEP SHIP TO: TRAILER
3400 W 131ST STREET
2264
CARMEL, IN 46074
I ,
;I
CREATED BY S,BR
REF NUMBER: DR0692797
FAX NUMBER: 3177332005
WORK: 317/733-2001 0 PO NUMBER: 1'F'
SALESMAN: MICHAEL S RUMMEL LICENSE: NO—VEHICLE
INVOICE DATE: 08/29/12 TERMS : NET 30 DAYS
---------------------------------------------------
PRODUCT
y-----------^^— ---W`_MECHANIC--QUANTITY—___ PRICE
_�___F_E_T_ EXTENSION
--
8 . 75R1.65/10 TRANSFRC HT ,BL 8 112 . 94 903 . 52
189F803
LTGI-IT TRUCK DISMNT/MNT — S�IOP 8316 8 . 00 10 . 00 80 . 00
LDMS
LIGHT TRUCK SNAP IN VALVE STEM 8 5 . 00 40 , Q0
LVALV
LIC14T TRUCK SCRAP DISPOSAL FEE 8 3 . 00 24 . 00
LDISP
TIRE USER FEE -- IN 8 . 25 2 . 00
950L13
CM#6406509078 DO'S
[ERCHANDISE: 943 . 52
LABOR: 80100
OTHER: 26 . 00
INVOICE TOTAL: 1049 . 52
A REPRINTED INVOTCF******
GOVERNMENT 1049 . 52
I
i
1
i
i
_ A firiance charge of 1.5%per month('I8/APR)will be added to the utlpaid wilEtdco after 30 days.
CUSTOMER ESTIMATE SELECTION I hereby autllorizc the bolo pair work to br.dnno,Wien.with necessary Inaterialn,You and
You are entitled to li Ilrloo ostlmate for tnc:rupalM you have autllorltud,The repair prlu,may ho les9 your employees may opera •I chicle for purposes of leafing,in:;poction or delivery at my rl,;k.
tna,l tho estimate but will lint oxceed the esthnato without your p0i'Mission.Your slgnawru will An r.xpress mechanic's li I ,:.IClanowledged on vehlcie to ix:curu the amount of repair,.
Indicate yuur nstlmato aelectlon. therato.Yuu will not be he p;eeponsiu o for loss or damage to vehlcla➢fir urlicloc left In vehicle
n case,of liro,theft.Eccid� dam;lgC from i'ruuzing due to lack of anti-1'reuZU or any other
1.I request an ustl nete in wrltlltry. hofuru you begin fepalrs, ,,. causes beyond your controli�.
2.plenso j,roccod with repairs but.c.,ill rnm before CUSTOMER SIGNATUR
continuing If price will uxa:,�xi 3__ In X
3.1 do not want an
Do you w,mt thr,replaced parts yuu rirr,cntltlod to7 OYFR Ea NU t;nnnASrD rnlce or•rir_anlhs
ADDITIONAL WORK AUTHORIZED BY:
f'j'1'hl:vellirin reeoived witltoul f u:r.is face customer cant:.jct. Q A.M. NAMC-
SHPN577025854
POMP'S TIRE-LAFAYETTE INVOICE #: 910003840
2700 SCHUYLER AVE
PAGE: 1
LAFAYETTE, IN 47905
765/742-4000
CUSTOMER: CITY OF CARMEL STREET DEP
3400 W 131ST STREET
2264
CARMEL, IN 46074
CREATED BY TIM
FAX NUMBER: 3177332005
WORK: 317/733-2001 0 PO NUMBER: 216
SALESMAN: MICHAEL S RUMMEL LICENSE: NO-VEHICLE
INVOICE DATE: 09/19/12 TERMS: NET 30 DAYS
-------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
12-16. 5 WASTE HAULER LUG 4 333.37 1333.48
745WHL
MERCHANDISE: 1333.48
INVOICE TOTAL: 1333.48
ON ACCOUNT A/R 1333.48
Signature Printed Name
Page 1
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))
08/29/12 830004693 $1,049.52
09/06/12 910003840 $1,333.48
I 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
Pomp's Tire- Lafayette
IN SUM OF $
. -afayette +N-46905- ���� ;,.Y lv
$2,383.00 5�31)' ._(b J G�
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
T
2201 830004693 42-320.00 $1,049.52 1 hereby certify that the attached invoice(s), or
2201 910003840 42-320.00 $1,333.48 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
Frid y Se ber 21, 2012
Street Commis4o er
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund