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Home My WebLink About233854 06/18/14 �/ \``. CITY OF CARMEL, INDIANA VENDOR: 358894 ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $*******262.85* ,�. ,?q CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 233854 °M}�TON-�b. CINCINNATI OH 45263-3197 CHECK DATE: 06/18/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 31988 01830-220610 262.85 WINDSHIELD REPLACE 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 01830-220610 INVOICE: 06/05/14 BD ORDERED: 06/03/14 INSTALLED: 06/05/14 PLEASE REMIT PAYMENT TO: W.O. # : 589884 REFERRAL#: 000000 SAFELITE FULFILLMENT, INC INSURED: P.O. BOX 633197 CARMEL POLICE DEPT CINCINNATI, OH 45263-3197 3 CIVIC SQ PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032-0000 PH1:317-571-2546 PH2: CARMEL POLICE DEPT Acct #: 405879 3 CIVIC SQ CARMEL IN 46032 POLICY# : PO#/REF CLAIM # : LOSS LOC: AUTH/VER: ED LOSS DATE/CAUSE: 06/05/14 2010 CHEVROLET IMPALA 4 DOOR SEDA ARR. MOBILE MILEAGE: 123 VIN: 2G1WD5EM9A1223322 LICENSE/ST: 15092 IN STOCK #: 74 --------------------------------- --------------------------------------------------- QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION 1 DWO1640 GTY 207.74 194.95 50.00 .00 .00 244.95 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 9.95 .00 .00 9.95 FUEL SURCHARGE PART TOTAL 194.95 LABOR TOTAL 67.90 SUB-TOTAL 262.85 SALES TAX 13.65 PAY T I S AMOUNT 276.50 TERMS: NET 30 ------------------- ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A SAFELITE AUTOGLASS # 01830 INDIANAPOLIS IN 46268-0000 SAFELITE TAX ID #: 36-4523816 060514-405879-405879 00669-405879-220610 CARMEL POLICE DEPT 3 CIVIC SQ CARMEL IN 46032 0000000020140605742 INDIANA RETAIL TAX EXEMPT PAGE City ®fCarmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 31fl69 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 512912014 ::J 2tolsto ALdo G1at;s Camwl Police Depa0ment VENDOR SHIP 3 Civic square Psi Box 6331p7 TO Carr ol, IN 46032 Clnciuuatl, OSI 45263=3197 1317)671_2559 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43-1510.00 1 Each Wndshield replacement $276.50 $276.50 Sub Total: $276.5fl jrF�f' t dE t r � ��It .:� �k� a "}§$• �� Car 74 Officer Zach Hasty Send Invoice To: Carmel Police Department Attn: Pat Young 3 Civic Squam Cannel, IN 46032. PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT Carmel Police Dept. i 2 PAYMENT $276.50 i.� t. • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFYTHATnIHERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATPI�SUFFICIENTTO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. •PURCHASE ORDER NUMBER MUSTAPPEAR ON ALL ORDERED BY / /i� SHIPPING LABELS. �Xi of®F Police •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 11 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V q CLERK-TREASURER DOCUMENT CONTROL NO. 31 8 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF$ I $ ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I 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__` 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 Safelite Auto Glass IN SUM OF$ PO Box 633197 Cincinnati, OH 45263-3197 $262.85 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members I hereby certify that the attached invoice(s), or 01830-220610 43-510.00 $262.85 q 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, June 12, 2014 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)) 06/11/14 01830-220610 Windshield Repair $262.85 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 5-11-10-1.6 120 Clerk-Treasurer