HomeMy WebLinkAbout225520 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 366480 Page 1 of 1
0 ONE CIVIC SQUARE POMP'S TIRE CHECK AMOUNT: $1,137.44
CARMEL, INDIANA 46032 ATTN:AR DEPARTMENT
��. PO BOX 1630
CHECK NUMBER: 225520
GREEN BAY WI 54305-1630
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 910014310 1, 137 .44 OTHER EXPENSES
CUSTOMER COPY REMITTANCE ADDRESS:
pomp's THE SELf1l ME9 mc. POMP'S TIRE SERVICE, INC.
ATTN:AR DEPARTMENT
° P.O. BOX 1630
h4yaoaaauun un a u o - i,
au++nnnnuu++nn+in� mi°siiiiir GREEN BAY,WI 54305-1630
POMP'S TIRE-LAFAYETTE WORK ORDER $#: .. 910014310
2700 SCHUYLER AVE
PAGE: 1,
LAFAYETTE, IN 47905
765/742-4000
CUSTOMER: CITY OF CARMEL WATER OPER
3450 W 131ST STREET '
2266
CARMEL, IN
46074, .
CREATED BY CFM
FAX NUMBER: 3177332053
WORK: . 317/733-2855 0
SALESMAN:. MICHAEL S RUMMEL
WRK ORD DATE: 10/07/13 TERMS : 1 PMT DUE 10TH OF MON AFTR INV
PRODUCT MECHANIC QUANTITY PRICE F..E:T. EXTENSION.
---------------y---------------------------------- ---- --------------
P235/70SR16 DEST. A/T OWL 8 141 . 93 1135 .44
026F767
TIRE USER FEE - IN 8 . 25 2 . 00
950L13
FIRESTONE GOVERNMENT SALE APPROVAL #7130
MERCHANDISE: 1135 .44
OTHER 2 : 00
WORK ORDER TOTAL: 1137 .44
Printed Name Signature
LUG NUTS 'MUST .BE RE-TORQUED AFTER 50-100 MILES . ✓
-'H,
A finance charge of 1.5%per month(18%APR)will be added to the unpaid balance after 30 days.
CUSTOMER ESTIMATE SELECTION I hereby authorize the below repair work to be donelalong with necessary materials.You and
You are entitled to a price estimate'for the repairs you have authorized.The repair price may be less your employees may operate vehicle for purposes of testing,inspection or delivery at my risk.
than the estimate but will not exceed the estimate'�without your permission.Your signature will An express mechanic's lien is acknowledged on vehicle to secure the amount.of repairs
indicate your estimate selection. thereto.You will not be held responsible for loss or damage to vehicle or articles left in vehicle
in of fire,theft,accident,damage from freezing due to lack of anti-freeze or any other
1.I request an estimate in writing before you begin repairs. causes beyond your control.
2.Please proceed with repairs but call me before CUSTOMER SIGNATURE X
continuing if price will exceed .$
3.1 do not want an estimate.
Do you want the replaced parts you are entitled to? ❑YES ❑NO ESTIMATED PRICE OF REPAIRS ADDITIONAL WORK AUTHORIZED BY:
A.M. .. NAME
❑This vehicle received without face to face customer contact. $ DATE TIME P.M. NO:CALLED NEW ESTIMATE
VOUCHER # 133117 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
910014310 01-6500-07 $1,137.44
Voucher Total $1,137.44
Cost distribution ledger classification if
claim paid under 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 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 10/14/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/14/201; 910014310 $1,137.44
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
i� ie O f
Date Officer