HomeMy WebLinkAbout229185 2/11/2014 "e. CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
CARMEL, INDIANA 46032 PO BOX 633197 CHECK AMOUNT: $146.95
CINCINNATI OH 45263-3197 CHECK NUMBER: 229185
CHECK DATE: 2/11/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4351000 01830212594 146 . 95 AUTO REPAIR & MAINTEN
SAFELITE FULFILLMENT, INC CUSTOMER SERVICE CENTER 1-800-835-2257
dba: Safelite Auto Glass, Elite Auto Glass,
Auto Glass Specialists, and IF YOU HAVE ANY QUESTIONS REGARDING
Diamond Triumph Glass PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830 -212594 INVOICE: 01/21/14 BD
ORDERED: 01/09/14 INSTALLED: 01/21/14
PLEASE REMIT PAYMENT TO: W.O. # : 556873 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL COMMUNITY SERVICE
CINCINNATI, OH 45263-3197 1 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032-0000
PH1:317-571-2444 PH2: '17`�57 22'444
CARMEL COMMUNITY SERVICE Acct #: 309353
E�`I�+�j j�.ajr„
1 CIVIC SQUARE le7C�1lJ D x
CARMEL IN 46032 cam!
� 2014�27 ��
Y Doug r,
POLICY# : PO#/REF r [• - �`
CLAIM # : LOSS LOC:
AUTH/VER: ADAM LOSS. DATE/CAUSE: 01/22/1.4' .
---------------------------------------------------- -
2005 FORD ESCAPE 4 DOOR UTIL ARR• MOBILE
MILEAGE: 1
VIN: 1FMCU96H76KA26087 LICENSE/ST: 68555 IN STOCK #:
-------- --- ---- ------- - --- - - ------ - -- --- - - - --- ------ ---- - - --- - - -- --- ----------------
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 MWSREPAIR .00 .00 74.94- .00 .00 74.94-
MOBILE WINDSHIELD REPAIR
1 DWO1579 GBYOEE 193.55 159.95 50.00 .00 .00 209.95
SOLAR-W/THIRD VISOR FRIT
1 DISPOSAL FEE 4.95 .00 7.95 .00 .00 7.95
DISPOSAL FEE
1 FUEL SURCHARGE 3.99 .00 3.99 .00 .00 3.99
FUEL SURCHARGE
PART TOTAL 159.95
LABOR TOTAL 13.00-
SUB-TOTAL 146.95
SALES TAX 0.00
P A Y T H I S A M O U N T 146.95
TERMS: NET 30
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
012214-309353-309353 00810-309353-212594
CARMEL COMMUNITY SERVICE
1 CIVIC SQUARE
CARMEL IN 46032 0000000020140122742
VOUCHER NO. WARRANT NO.
ALLOWED 20
Safelite Fulfillment, Inc.
IN SUM OF $
P.O. Box 633197 i
Cincinnati, OH 45263-3197
$146.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1192 I 01830-212594 I 43-510.00 I $146.95 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
Friday, February 07, 2014
Direc
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))
01/09/14 01830-212594 Repair cracked windshield $146.95
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