219687 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 060700 Page 1 of 1
ONE CIVIC SQUARE CLARK TIRE INC
CARMEL, INDIANA 46032 622 C SOUTH RANGELINE RD CHECK AMOUNT: $84.00
CARMEL IN 46032 CHECK NUMBER: 219687
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350101 138296 84 . 00 TRASH COLLECTION
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CCLRK 622C S. Rangehne Road
"YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 46032
4w (317) 844-4839
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I.THE UNDERSIGNED,HEREBY AGREE UNTIL SUCH TIME AS THIS ACCOUNT IS PAID IN FULL BY ME,THE SELLER SHALL RETAIN TITLE TO THE GOODS HEREBY PURCHASED AND SELLER SHALL HAVE
A SECURITY INTEREST IN SAID GOODS TO SECURE THE PAYMENT UNTIL MY ACCOUNT IS FULLY PAID.I FURTHER AGREE THAT IN THE EVENT OF DEFAULT IN THE PAYMENT OF ANY AMOUNT DUE,AND
IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO PAY AN ADDITIONAL CHARGE EQUAL TO THE COST OF COLLECTION INCLUDING
AGENCY AND ATTORNEY FEES AND COURT COSTS INCURRED AND PERMITTED BYLAWS GOVERNING THESE TRANSACTIONS.
A finance charge of 13/4%Per Month will be charged on all Accounts 30 days Past Due. Annual Percentage Rate is 21%.(Minimum 75) RECEI VET BY
SOLD TO- SHIP TO
'CARMEL POLICE DEPT. 5000/01 SAME INVOICE# 138295
THREE CIVIC SWARE
CARMEL IN 451432
CUST. P.O.# MAKE-MODEL ID# MILEAGE TRI EP ONE ROUTE SLM SHIP VIA ORDER# PAGE REMARKS
571-2500 0 5 N/A 154894 1
INVOICE DATE INVOICE PREVIOUS SHIPPED TERMS
NUMBER INVOICE NUMBER
J by operator # a
04./25/2013 1382% NET 10TH 04/25113 10:51:45 8
STOCK NUMBER SIZE DESCRIPTION QUANTITY. _ UNIT T F.E.T. EXTENSION
ORDERS SHIPPED PREV.SHIP, PRICE
SCRAP SCRAP TIRE 28 28 3.00 .t0 84.00
METHOD OF PAYMENT:
CHARGE: 84.00
CHANGE: .00
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thank you for your business `
TAXABLE AMOUNT TAX LABOR TAX% F.E.T. misc. iINVOICE TQTAG UNT
84.00 84.00
"You're Riding On Our Reputation"
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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))
04/26/13 138296 28 scrap tires $84.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Clark Tire
IN SUM OF $
622 C South Rangeline Road
Carmel, IN 46032
$84.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 138296 43-501.01 $84.00 I 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
Wednesday, May 01,2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund