214785 11/20/2012 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
0 ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $686.36
�? CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT
PO BOX 1630
o„ CHECK NUMBER: 214785
GREEN BAY WI 54305-1630
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 830004810 686 . 36 OTHER EXPENSES
Nov I M Ham W/V
A"17N:AR DEPARTMENT
P.O. BOX 1630
GRFF,.N BAY,WI 54305-1630
°t°nhe°acau•�6hAhh4h9d��1 I!IYLM�icioiaacl�7a'
POMPIS TIRE—LEBANON INVOICE #: 830004810
1316 WEST SOU'T'H STREET
PAGE: 1
LEBANON, IN 46052
765/482-4359
CUSTOMER: CITY OF CARME.L WATER OPER SHIP TO: C/t REPLACE
3450 W 131ST STREET
2266
CARMEL, IN
46074
CREATED BY SBR
REF NUMBER: DR0692796
FAX NUMBER: 3177332053
WORK: 317/733-2855 0 PO NUMBER: GOV 0692796
SALESMAN: MICHAEL S RUMMEL LICENSE: NO—VEHICLE
INVOICE DATE : 08/29/12 TERMS : DUE 10TH OF THE MFI
—_--------------------------------------------------_-------------- ---------------
PRODUCT MECHANIC QUANTITY I PRICE F.E .T. EXTENSION
--------•-'---------------_,.._--W---------------------.._------------_.,_.------—'__--
LT265/70R17/1,0 TRANSFRC AT WL 4 151 . 34 605 . 36
20OF190
TIRE USER FEE — IN 4 .25 1. 00
95OL13
LIGHT TRUCK SPIN BALANCE 8312 4 . 00 12 . 00 48 . 00
LB,AL
LIGHT TRUCK SCRAP DISPOSAL FEE 4 4 . 00 16 . 00
LDISP
LIGHT TRUCK SNAP IN VALVE STEM 4 4 . 00 16 . 00
LVALV
CM#6406509066 DJS
MERCHANDISE: 621. 36
LABOR: 48 . 00
OTHER; 17 . 00
INVOICE TOTAL: 686 . 36
******THIS IS A REPRINTED INVOICE******
GOVERNMENT 686 . 36
A finsnce clYtrge of 1.5/pel'month(189.APrt)will bu added to the 11111), balance after'10 rtgy„
CUSTOMER.ESTIMATE SELECTION I hereby aulhorizo the below repair wrrl<to hr,done along wlut nurc,Vsary materials.You and
You are emilled to a price estlmot,':for tho repah s you ri;tvo authcrized.Tru-ropalr price may hr:loss yo!ir umployees may oporaw vehicle for purpa:es of Costing,Inspection or(julivory at my rlak.
Illein the estimate but will not exceed irw ostlmate wlthoul your permission. Your signature will An t1xi')rocs mechanic's lien i>::.tr;knowledged on ywhirlu to secure the anrn mi of repairs
Indlerilu your estimate selerllon, thereto.You will riot be held resprnslblo for lose or damage:•lo vehicle er article:lift in vohicie
1.1 request an cslimate in writllig b0luru you begin iopalrs, in case of fire, thof1,occident,damage irrgn frcozing due to Isrl<or mili-freeze or any other
— _ causes beyond your control.
2.f lease:ling If d with rl f)xce but call me before CUSTOMER SIGNATURE X
contlnulny If price will excosd 9;., _ _ _
3.1 do not w:z,,l un ostlmate.
Do yqu_want the-replsrcd.,parts you.aro anlitlnri to? fa YES ONO CS-fIMnY'FD PIiICf_OF R[PNI�S ADDITIONAL WORK AUTHORIZED BY- _
C7 This:vohlcle recemiu without face to taco<a eJtOmer contact. $ A.M. NAME
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
366480
Pomp's Tire Purchase Order No.
PO BOX 1630 Terms
GREEN BAY, WI 54305-1630 Due Date 11/12/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/12/201', 830004810 $686.36
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC(�5-11-110-1.6
Date Officer
VOUCHER # 122717 WARRANT # ALLOWED
366480 IN SUM OF $
Pomp's Tire
PO BOX 1630
GREEN BAY, WI 54305-1630
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
830004810 01-6500-05 $686.36
Voucher Total $686.36
Cost distribution ledger classification if
claim paid under vehicle highway fund