218129 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 182450 Page 1 of 1
ONE CIVIC SQUARE LEBANON TIRE&AUTO SVC CHECK AMOUNT: $296.64
` CARMEL, INDIANA 46032 1310 W SOUTH ST
LEBANON IN 46052 CHECK NUMBER: 218129
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 LOOD82 170 . 10 OTHER EXPENSES
1120 4351000 LOODAM 126 . 54 AUTO REPAIR & MAINTEN
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 02/08/13 07: 17 AM
1310 W. SOUTH STREET file id: LEB-17230 Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: LOODAM L00259 1 ST 10TH
Sold-To: Ship-To: Type - Payment
CARMEL FIRE DEPT $
2 CIVIC SQUARE $
CARMEL-,—IN-- 46032 _____________
Total $ 0.00
**MEMBER OF THE GOODYEAR TIRE & SERVICE NETWORK** REP 317-664-0958
317-571-2615
!R! SCU;UNIT C;BOX 21, .59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init's
1 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 85.00 202,220
1 046100000 FLAT STEER 106TH & SHELBOURNE 28.00 28.00 202,220
1 041263000 NEW VALVE STEM 4 .50 4.50 202
BOB VANVORST '
SHOP SUPPLIES 9.04
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V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$126.54
IN GOV'T,0.000%
$0.00
Total: __S 12.6_.5.4
NewPymt: $0.00
Total Due: $126 . 54
Received By: SP: /202
PP:Terry Millikan
VOUCHER NO. WARRANT NO.
ALLOWED 20
Lebanon Tire
IN SUM OF $
1310 West South Street
Lebanon, IN 46052
$126.54
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 I LOODAM I 43-510.00 I $126.54 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 exce
al
Fire Chief
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))
LOODAM Tire Repair $126.54
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
120
Clerk-Treasurer
LEBANON TIRE & AUTO SERVICE
1310 W. SOUTH STREET
LEBANON, IN 46052
Store Location Store Phn Date Time
R & T Tire/Auto - LEB (765) 482-5027 02/12/13 07 : 18 AM
1310 W. SOUTH STREET file id: LEB-17246 Page 1
LEBANON, IN 46052
Your P/O # A/R Acct# Terms Ship Via
Inv: LOODB2 L02634 1st 10th
Sold-To: Ship-To: Type - Payment
CARMEL WASTE WATER $
9609 HAZEL DELL RD $
INDIANAPOLIS, IN 46280 __________ - — --- --
Total $ 0.00
**MEMBER OF THE GOODYEAR TIRE & SERVICE NETWORK** REP 317-571-2634
!R! SCU;UNIT C;BOX 21, .59,B;RPU;EXIT;
Qty Shp B/O Item Number Description S/W FET Price Amount Init' s
1 046120000 ROAD SERVICE PER HR/PER MAN (R 85.00 85.00 202,220
1 046100000 TIRE REPAIR 15.5-25 TELEHANDLE 72.50 72.50 202,220
FORK LIFT TELEHANDLER
MR COOPER
SHOP SUPPLIES 12.60
--------------------
V/Info:
------------------------------------------------------------------------------------------------
Sub-Total
$170. 10
Sales Tax
$0.00
Total: $170 . 10
NewPymt: $0.00
Total Due: $170 . 10
Received By: SP:Terry Millikan
VOUCHER # 135081 WARRANT # ALLOWED
182450 IN SUM OF $
LEBANON TIRE & AUTO SVC
1310 W SOUTH ST
LEBANON, IN 46052
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
LOOD62 01-7500-02 $170.10
Voucher Total $170.10
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
182450
LEBANON TIRE &AUTO SVC Purchase Order No.
1310 W SOUTH ST Terms
LEBANON, IN 46052 Due Date 3/7/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/7/2013 LOODB2 $170.10
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_
.31sl3
Date Officer