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221460 07/02/2013 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: $89.95 CARMEL IN 46032 CHECK NUMBER: 221460 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 138891 89 . 95 OTHER EXPENSES I CCRK 622C S. Rangeline Road "YOU ARE RIDING ON OUR REPUTATION" Carmel, IN 46032 4w M (317) 844-4839 i RE t rational PENS IL 1,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 BY LAWS GOVERNING THESE TRANSACTIONS. A finance charge of 13/4%Per Month will be charged on all Accounts 30 days Pas(Due.Annual Percentage Rate is 21%.(Minimum 75) RECEIVED BY SOLD TO: SHIP TO: CARMEL WATER DISTRIBUTION 6300/01 SANE INVOICE# 138891 3450 W. 131ST ST. CARNEL IN 46074 r✓� G 17 CLIST.P.O.# MAKE-MODEL # MILEAGE TELEPHONE ROUTE SLM SHIP VIA ORDER# PAGE REMARKS 733-2853 #132 105939 716-3939 0 1 NIA .155255 1 INVOICE DATE INVOICE 1OUS SHIPPED TERMS NUMBER INVOICE NUMBER Opened by Operator # 7 06/26/2013 138891 NET 10TH 06/26/13 14:11:39 7 STOCK NUMBER SIZE DESCRIPTION QUANTITY UNIT T F.E.T. EXTENSION ORDERS SHIPPED PREV.SHIP PRICE AL3 EACH LIGHT TRUCK ALIGNMENT 1 1 89.95 .00 89.95 METHOD OF PAYMENT: CHARGE: 89.95 CHANGE: .00 i I I I r ink you for your busiress Nech: Dou PARTS LABOR TAX% AMOUNT TAX F.E.T. AMOUNT INVOICE TOTAL — - - P EASE PAY THIS AMOUNT - 89.95 89.95 "You're Riding On Our Reputation" 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 60700 CLARK TIRE INC CARMEL Purchase Order No. 622 C SOUTH RANGELINE RD Terms CARMEL, IN 46032 Due Date 6/27/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/27/2013 138891 $89.95 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 Y/I/,/// Date dik er VOUCHER # 131956 WARRANT # ALLOWED 60700 IN SUM OF $ CLARK TIRE INC CARMEL 622 C SOUTH RANGELINE RD CARMEL, IN 46032 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 138891 01-6500-05 $89.95 Voucher Total $89.95 Cost distribution ledger classification if claim paid under vehicle highway fund