221669 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
ONE CIVIC SQUARE POMP'S TIRE
CHECK AMOUNT: $455.68
CARMEL, INDIANA 46032 ATTN AR DEPARTMENT
PO Box 1630 CHECK NUMBER: 221669
GREEN BAY WI 54305-1630
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 830017116 455 . 68 OTHER EXPENSES
SHPN577129754
POMP'S TIRE-LEBANON INVOICE #: 830017116
1316 WEST SOUTH STREET
LEBANON, IN 46052 PAGE: 1
765/482-4359
CUSTOMER: CITY OF CARMEL WATER OPER
3450 W 131ST STREET
2266
CARMEL, IN
46074
CREATED BY RNR
REF NUMBER: DR0846852
FAX NUMBER: 3177332053
WORK: 317/733-2855 0 PO NUMBER: JIM
SALESMAN: MICHAEL S RUMMEL
INVOICE DATE: 06/14/13 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F. E.T. EXTENSION
-------------------------------------------------------------------------------
LT245/75R16/10 TRANSFRC AT BL 4 113.67 454.68
189F582
TIRE USER FEE - IN 4 .25 1.00
95OL13
CM#6414525788 D]S
MERCHANDISE: 454.68
OTHER: 1.00
INVOICE TOTAL: 455.68
GOVERNMENT 455.68
THANK YOU FOR YOUR BUSINESS! ! ! !
LUG NUTS SHOULD BE RE-TORQUED AFTER 50-100 MILES
signature Printed Name
Page 1
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
366480
Pomp's Tire Purchase Order No.
PO BOX 1630 Terms
GREEN BAY, WI 54305-1630 Due Date 6/25/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/25/2013 830017116 $455.68
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
Date Acer
VOUCHER # 131910 WARRANT # ALLOWED
366480 IN SUM OF $
Pomp's Tire
PO BOX 1630
GREEN BAY, WI 54305-1630
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
830017116 01-6500-05 $455.68
I
i
Voucher Total $455.68
Cost distribution ledger classification if
claim paid under vehicle highway fund