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Home My WebLink AboutMATTHEW D WORTHLEY -002251 -9/22/2011 CARMEL REDEVELOPMENT COMMISSION 0 0 2 2 51 Matth N D Worthley Check: 2251 5711 11th Street, NW Date: 9/22/2011 Carmel, IN 46032 Vendor: WORTHL1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 28430855 93.08 93.08 0.00 0.00 93.08 Truck rental for IT move 93.08 93.08 0.00 0.00 93.08 Rental Agreement Cover Sheet PENSKE Rental Agreement#:28430855 COMMERCIAL LOCAL Created by: d.CLAYTON Completed by: d.CLAYTON Pick Up Date: 09/20/11 09:00 AM 24/7 Roadside Assistance: Entered At: 0508-21 Expected Return Date: 09/21/11 09:00 AM 1-800-526-0798 Status: COMPLETED Actual Return Date: 09/20/11 11:00 AM CHARGES Type Quantity Unit of Meas Rate Charge Unit#:511870 2 Hour $21.25 $42.50 Mileage Out: 190,349 In: 190,373 24 Miles $0.240 $5.76 Ldw$1000 Responsibility 1 Day $20.00 $20.00 Liability Accident Insurance 1 Day $10.00 $10.00 environmental fee 1 DY $2.00 $2.00 Diesel Fuel 1.6 GA $4.50 $7.20 SUBTOTAL: $87.46 TAXES IN SALES TAX $5.62 TOTAL DUE: $93.08 PAYMENTS AND REFUNDS Pay Type Trans Date Card# Approval Code PYMT 09/20/2011 06538B on 09/20/2011 ($93.08) PAYMENT: ($93.08) e2.3909, NET DUE: $0.00 Customer acknowledges that Customer has read,or been given and opportunity to read,the Rental Agreement, including this Cover Sheet,the General Terms and Conditions,as well as any attachments hereto and agrees to be fully bound by its terms. To the extent the Customer had purchased Limited Damage Waiver coverage,Customer acknowledges reading,understanding,and agreeing with the disclosures,exclusions,and terms and conditions applicable to Limited Damage Waiver as set forth in Attachment D to the Rental Agreement. By: (ej Customer/Authorized Signatory Page 2 of 4 Rental Agreement Cover Sheet Rental Agreement#:28430855 COMMERCIAL LOCAL PENS/CE Created by: d.CLAYTON Completed by: d.CLAYTON Pick Up Date: 09/20/11 09:00 AM 24/7 Roadside Assistance: Entered At: 0508-21 Expected Return Date: 09/21/11 09:00 AM 1-800-526-0798 Status: COMPLETED Actual Return Date: 09/20/11 11:00 AM CUSTOMER INFORMATION PICK UP/DROP OFF LOCATION Acct: 32CC8E00 INDIANA XPRESS RENTALS(0508-21) CARMEL REDEVEL COMMISSION 1372 SOUTH 10TH STREET 30 W MAIN NOBLESVILLE, IN 46060 USA CARMEL, IN 46032 USA Voice(317)578-4200 Day(317)205-2030 Fax(317)773-4800 DRIVER NAME(S): TERRY CROCKETT TRAVEL SCOPE: Intrastate This lessor cooperates with all Federal,State,and local law enforcement officials nationwide to provide the identity of customers who operate this rental CMV UNIT INFORMATION Unit#:511870 Max. Payload: 11,500 lbs. Rented With Damage: NO 2026-26FT SAD MEDIUM VAN Height: 13 ft.0 in. Returned With Damage:NO License#:70433 Mileage Out: 190,349 License State: IN Mileage In: 190,373 License Exp: 02/28/2011 Fuel Out: FULL Owning Location:5111-10 Fuel In: 15/16 NO HAZARDOUS MATERIAL BEING TRANSPORTED OPTIONAL PROTECTION PLANS Limited Damage Waiver/LDW$1000 Responsibility *ACCEPTED* Rates:$433.33/month $100.00/week $20.00/day Limited Damage Waiver/LDW$5000 Responsibility *DECLINED* Supplemental Liability *DECLINED* Liability Coverage/LIABILITY ACCIDENT INSURANCE *PENSKE PROVIDES* Rates:$433.33/month $100.00/week $10.00/day THIS CONTRACT OFFERS, FOR ADDITIONAL CHARGE OPTIONAL VEHICLE PROTECTION TO COVER YOUR FINANCIAL RESPONSIBILITY FOR DAMAGE OR LOSS TO THE RENTAL VEHICLE. THE PURCHASE OF OPTIONAL VEHICLE PROTECTION IS OPTIONAL AND MAY BE DECLINED. YOU ARE ADVISED TO CAREFULLY CONSIDER WHETHER TO PURCHASE THIS PROTECTION IF YOU HAVE A RENTAL VEHICLE COLLISION COVERAGE PROVIDED BY YOUR CREDIT CARD OR AUTOMOBILE INSURANCE POLICY. BEFORE DECIDING WHETHER TO PURCHASE OPTIONAL VEHICLE PROTECTION, YOU MAY WISH TO DETERMINE WHETHER YOUR CREDIT CARD OR VEHICLE INSURANCE AFFORDS YOU COVERAGE FOR DAMAGE TO THE RENTAL VEHICLE AND THE AMOUNT OF DEDUCTIBLE UNDER SUCH COVERAGE. Page 1 of 4 ,/ 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 ) /197i forel l�/a Tf2 /�j Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9/2t/i, ? i/3 OS sS *Tv- = r�./71.91 / .1— 7- /Li6,v,, Gg 43 e iT, Rr i1 Total g3. G?' I hereby certify that the attached invoice(s), or bill(s), is (are) true . •rrer. .nd I have audited same in accordance with IC 5-11-10-1.6. 0411111% , 20 ____ /✓Allr Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 I/ _ IN SUM OF $ $ 93, o8 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT hereby certify invoice(s),DEPT.# I hereb certif that the attached invoices , or got 2893(455 F23 5)1 9 y,og 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 9-2/ 20// Exegittietirector Cost distribution ledger classification if Title claim paid motor vehicle highway fund Cannel Redevelopment Commission !,