217786 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
j ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $467.24
CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT
PO BOX 1630 CHECK NUMBER: 217786
GREEN BAY WI 54305-1630
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 910007361 467 . 24 OTHER EXPENSES
SHPN57707192
3
POMP'S TIRE-LAFAYETTE
2700 SCHUYLER AVE INVOICE #: 910007361
LAFAYETTE, IN 47905 PAGE: 1
765/742-4000
CUSTOMER: CITY OF CARMEL WATER OPER SHIP TO: DELIVERED VIA SHANE R.
2266 3450 W 131ST STREET
CARMEL, IN
46074
CREATED BY DBL
REF NUMBER: HGS113533
FAX NUMBER: 3177332053
WORK: 317/733-2855 p
SALESMAN: MICHAEL S RUMMEL PO NUMBER: GOV
INVOICE DATE: 02/11/13 ------------TERMS_-1 PMT DUE 10TH OF MON AFTR INV
PRODUCT ------------------------------
-----MECHANIC QUANTITY PRICE F.E.T. EXTENSION
------------------ ___________ __
P235/70TR17 HANKOOK RH12 XL BL ------------------
101H2468 4 116. 56 466.24
TIRE USER FEE - IN 4
950L13 • 25 1.00
GOV HK HGS201202
MERCHANDISE: 466.24
OTHER: 1.00
INVOICE TOTAL: 467.24
GOVERNMENT 467.24
LUG NUTS SHOULD BE RETORQUED AFTER 50 TO 100 MILES
Signature Printed Name
Page 1
I
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 2/18/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/18/2013 -910007361 $467.24
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
Date Officer
VOUCHER # 123572 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
910007361 01-6500-04 $467.24
'I
Voucher Total $467.24
Cost distribution ledger classification if
claim paid under vehicle highway fund