222544 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
ONE CIVIC SQUARE POMP'S TIRE
CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT CHECK AMOUNT: $647.72
PO BOX 1630
„a CHECK NUMBER: 222544
GREEN BAY WI 54305-1630
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232000 910011603 647 . 72 TIRES & TUBES
SHPN577147215
POMP'S TIRE-LAFAYETTE INVOICE #: 910011603
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
2264
CARMEL, IN
46074
CREATED BY DBL
REF NUMBER: DR0907296
FAX NUMBER: 3177332005
WORK: 317/733-2001 0 PO NUMBER: GOV
SALESMAN: MICHAEL S RUMMEL
INVOICE DATE: 07/20/13 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
-------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
LT235/85R16/10 BS DURAVIS R500 4 161.68 646.72
1918843
TIRE USER FEE - IN 4 .25 1.00
950L13
GOV B/S 7130
CM#6415519823 D7S
MERCHANDISE: 646.72
OTHER: 1.00
INVOICE TOTAL: 647.72
GOVERNMENT 647.72
Signature Printed Name
- LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES.
Page 1
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
$647.72
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 910011603 I 42-320.001 $647.72 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
Fri I 6 013
UUAIW
She I�IT���A @fir
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
07/20/13 910011603 $647.72
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