221933 07/17/2013 CITY OF CARMEL, INDIANA VENDOR: 00351640 Page 1 of 1
Q � ONE CIVIC SQUARE CLARK TIRE FISHERS CHECK AMOUNT: $92.25
CARMEL, INDIANA 46032 PO BOX 195
FISHERS IN 46038 CHECK NUMBER: 221933
CHECK DATE: 7/17/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 IN00134230 92 . 25 EQUIPMENT REPAIRS & M
126TH & REYNOLDS ROAD (HWY 37 NO.)FISHERS, INDIANA A 46038 FAST!T! Service at our Farm,
.00� P.O. BOX 1 Commercial Site or on the Road.
TIRE FISHERS 317-842-0544 OR 1-800-444-5985 All Major Brands Available
Fax 317-577-3956
I
NAME/ADDRES S I , ACCOUNT NO. HOME PHONE REFERENCE NO.
BROOKESH (317)571-2427 I I'd001,?,4•e_',:30
BROOKSHIRE GOLF CLUB P.O.NO. WORKPHONE DATE/TIME
12120 BROOKSHIRE PARKWAY (31 7) —• 07/69/13 12:23
RESALE NO. VIN NO. WO-ES NO.
CAKLt IN 45033 WO00089838
YEAR/MAKE/MODEL LICENSE NO. TAG NO. NEXT INSP.DATE BAR NO.
SAVE PARTS ALL PARTS NEW UNLESS PROMISED DATE/TIME MILEAGE WRITTEN BY
Y N OTHERWISE SPECIFIED BO
ORIGINAL ❑ FREE ROTATION
REVISED 1 (EVERY 5,000 MILES)
REVISED 2
I acknowledge notice and oral approval of an increase in the original estimate price. ❑ ROAD HAZARD WARRANTY
X )I,
PARTS & OTHERS LABOR
EACH DESCRIPTION
•
1 511408 23%10.50-12/4 TURFNASTER 85.00 85.00 1.00 INDIANA TIRE FEE 0.25
1 TV TIRE VALUE 2.00 2.00 1.60 LABOR 5.00
i
Reason for original estinates
Any warranties on the itemlitems sold hereby are those made by the manufacturer.The seller,CLARK TIRE,hereby expressly
disclaims all warranties either express or implied,including any implied warranty of merchantability or fitness for a particular
purppoose,and CLARK TIRE neither assumes nor authorizes any other person to assume for it any liability in connection with the sale
of this Item/items.
A SERVICE CHARGE OF 1Y.%PER MONTH(21%ANNUALLY)WILL BE CHARGED ON ALL ACCOUNT PAST DUE 30 DAYS.NET 10th PROX.THE fHE HUANDERSIG OF AN AGENCY OR ATTORNEY FOR COLLECTION OR LEGAL ACTION TO OF AY AN ADDITIONAL CHARGE IEQUALL TO T'HE COST OF PARTS 87• X110
COLLECTION INCLUDING AGENCY AND ATTORN Y FEES D COURT COSTS INCURREb AND PERMITTED BYLAW GOVERNING THESE TRANSACTIONS
LABOR .c�a ��J
1 hereby authorize the re air work to bone ng with a nec ry materials.You and your employees may operate vehicle for purposes of testing, OTHER
inspection,or delivery in y risk.An expres echaniclien nowledged on vehicle to secure the amount of repairs thereto.It is also understood that
you will not be held re onsible foror amage t c rs les left in cars in case of fire,theft or any other cause beyond your control. SUBLET
Signature X SUBTOTAL Oryd `S
TAX O. OL
Rec'd By TOTAL 92- 25
CASH AMOUNT CHECK AMOUNT CHECK NO. C.C.AMOUNT C.C.TYPE C.C.APPROVAL CODE ON ACCOUNT
1/, 92.2'5 U!
THANK
YO
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))
07/09/13 IN00134230 Repair Parts $92.25
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 Fishers
IN SUM OF $
P.O. Box 195
Fishers, IN 46038
$92.25
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I IN00134230 I 43-500.00 I $92.25 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
Wednesday, July 10, 2013
Director, Brooksllr Golf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund