224631 09/25/2013 CITY OF CARMEL, INDIANA VENDOR: 00350983 Page 1 of 1
' ONE CIVIC SQUARE R&T TIRE&AUTO NOBLESVILLE
0 - CHECK AMOUNT: $9,511.72
CARMEL, INDIANA 46032 17016 CLOVER ROAD
NOBLESVILLE IN 46060 CHECK NUMBER: 224631
CHECK DATE: 9/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4232000 25421 NOOMGP 9, 511 . 72 TIRES
09/12/2013 09:49 3177733139 RTAUTONOBLESVILLE #1921 P. 003/003
R T Tire—Noblesville R&T Frankfort(765)654-5588
17016 Clover Rd R&T Sheri Lebanon(765)492-5027
R&T Sheridan(317)758-d4Sb
Noblesville,IN 46060 R&T Tipton(765)675-6775
317-773-3130
3iacA lass
Store Location Store Phn Date Time
R & T Tire/Auto - NOB (317) 773-3130 09/12/13 10 :36 AM
17016 CLOVER RD file id: NOB-29113 Page 1
NOBLESVILLE, IN 46060
Your P/0 # A/8 Aeet# Te=S ship Via
InV: NO 0140P ITASON N05743 1 ST 10TH
Sold-To: Ship-To: Type - Payment
CARMEL POLICE DEPARTMENT $
3 CIVIC SQUARE $
CARMEL, IN 46032
Total 0.00
S 0.00
*'"MEMBER OF THE GOODYEAR TIRE & SERVICE NETWORK" ' ARC 317-571-2546 GRAG W
Qt:y Shp 13/0 Item Number Description S/W PET Price Amount Init's
20 GY732354500 P225/60R16 97V S2 EAG :RS-4 89.50 1790.00 5
20 GY7320025DO P255/55R17 98W 52 F4AG. RS-A 106.92 2138.40 5
20 GY732301500 P265/60R17 108V SL £AG RS=A 126.69 2533.80 5
8 GY732276500 P235/5GR•18 99W'XS, RAG RS A 127.80 1022.40 5
4 GY748535189 LT6a/7C1R17;..WR>A, ST7,70RMR;.PROGRT}.• 200.59 802.36 5
4 GY732026500 ;45%5aR .8 "10;3'V GY BA3L1r iZS=R" 127.80 511.20 5
4. GY748187189 ' T2'S/..7. R17 I14:12 .Wn.S�TARMR .0 ".:..., 778.39 713.56 5
V/Info: -
Sub-Total
$9511.72
:... :. IN GOV'T,0.000*
$0.00
Total: $9511.72
NewPymt: $0.00
Total Due; $9511.72
Received By: SP:Chuck Godby
INDIANA RETAIL TAX EXEMPT PAGE
Cloty .of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 25421
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
W10013- .
R&T Tire andAuto Carmel Police Department
VENDOR SHIP 3 Civic Squam
TO
17016 Clover Road Carmel, IN 46032
Noblesville IN JIM 317 571
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-320.00
84 Each tires $121.73 $10,225.28
Sub Total: $10,225.28
®° '
IM
Send Invoice To:
t
s
Carmen Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $10,223.28
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. IS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
'25421 CLERK-TREASURER
DOCUMENT CONTROL NO. VENDOR COPY
VOUCHER NO. WARRANT NO.
ALLOWED 20
R & T Tire and Auto
IN SUM OF $
17016 Clover Road
Noblesville, IN 46060
$9,511.72
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#1 Dept. INVOICE NO. ACCT#(TITLE AMOUNT Board Members
25421 PI NOOMGP I 42-320.00 I $9,511.72 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
Thursday, September 19, 2013
Chief of Police
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))
09/12/13 NOOMGP tires $9,511.72
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
20
Clerk-Treasurer