223154 08/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $1,139.60
CARMEL, INDIANA 46032 ATiN:AR DEPARTMENT
o��o PO BOX 1630 CHECK NUMBER: 223154
GREEN BAY WI 54305-1630
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 910011902 1, 139 . 60 OTHER EXPENSES
SHPN577150059
POMP'S TIRE-LAFAYETTE INVOICE #: 910011902
2700 SCHUYLER AVE
PAGE: 1
LAFAYETTE, IN 47905
765/742-4000
CUSTOMER: CITY OF CARMEL WATER OPER SHIP TO: DELIVERED VIA S. RUMMEL
3450 W 131ST STREET 12 SCRAP TIRES PICKED UP
2266
CARMEL, IN
46074
CREATED BY DBL
REF NUMBER: DR0907301
FAX NUMBER: 3177332053
WORK: 317/733-2855 0 PO NUMBER: GOV
SALESMAN: MICHAEL S RUMMEL
INVOICE DATE: 07/26/13 TERMS: 1 PMT DUE 10TH OF MON AFTR INV
-------------------------------------------------------------------------------
PRODUCT MECHANIC QUANTITY PRICE F.E.T. EXTENSION
-------------------------------------------------------------------------------
LT265/70R17/10 TRANSFRC AT WL 8 134.70 1077.60
200F190
TIRE USER FEE - IN 8 .25 2.00
950L13
GOV F/S 7130
LIGHT TRUCK SCRAP DISPOSAL FEE 12 5.00 60.00
LDISP
CM#6415742042 D7S
MERCHANDISE: 1077.60
OTHER: 62.00
INVOICE TOTAL: 1139.60
GOVERNMENT 1139.60
Signature Printed Name
LUG NUTS MUST BE RE-TORQUED AFTER 50-100 MILES. 01`
LA
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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 8/6/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/6/2013 910011902 $1,139.60
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 Officer
VOUCHER # 132325 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
910011902 01-6500-04 $569.80
910011902 01-6500-05 $569.80
t
Voucher Total $1,139.60
Cost distribution ledger classification if
claim paid under vehicle highway fund