221199 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
ONE CIVIC SQUARE POMP'S TIRE
CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT CHECK AMOUNT: $1,189.62
PO BOX 1630 CHECK NUMBER: 221199
GREEN BAY WI 54305-1630
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 9100008791 1, 189 . 62 TIRES & TUBES
POMP' S TIRE-LAFAYETTE INVOICE #: 910008791
2700 SCHUYLER AVE
PAGE: 1
LAFAYETTE, IN 47905
765/742-4000
CUSTOMER: CITY OF CARMEL STREET DEP SHIP TO: DELIVERED VIA S. RUMMEL
3400 W 131ST STREET REPLACED 2 TIRES
2264
CARMEL, IN
46074
I
CREATED BY DBL
REF NUMBER: DR497692
FAX NUMBER: 3177332005
WORK: 317/733-2001 0 PO NUMBER: GOV
SALESMAN: MICHAEL S RUMMEL
INVOICE DATE: 04/12/13 TERMS : 1 PMT DUE 10TH OF MON AFTR INV
-------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
11R22 .5/16 GOODYEAR G182 RSD 2 417 . 06 834 . 12
138G803185
TIRE USER FEE - IN 2 . 25 0.50
950L13
GOV GY G0002624
TRUCK DISMOUNT/MOUNT-LOOSE-SHP 9118 4 . 00 28 . 00 112 . 00
TDMLS
STANDARD BRASS TRUCK VALVE 4 6 . 00 24 . 00
TVALV
10 OZ BAG COUNTERACT 4 20 . 00 80 . 00
OlOC
USED 8 .25X22 . 5 10H HP STL WHL 2 35 . 00 70. 00
UWHL
POWDER COAT RIM/WHL RECONDITON 2 32 . 00 64 .00
RECON
SHOP SUPPLIES 1 5 . 00 5 . 00
SUPL
PO# JEFF
CM##74877678 DJS
MERCHANDISE: 1077. 12
LABOR: 112 . 00
OTHER: 0. 50
INVOICE TOTAL: 1189. 62
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))
04/12/13 910008791 $1,189.62
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
Pomp's Tire Service, Inc.
A/R Department IN SUM OF $
p. O. Box 1630
Green Bay, WI 54305-1630
$1,189.62
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 1 910008791 1 42-320.001 $1,189.62 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 except
/ ) _ r day e 14, 2013
U66"
Street Commissi n r
Street-GemmissTen--
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund