HomeMy WebLinkAbout234395 07/01/14 �._4 CITY OF CARMEL, INDIANA VENDOR: 358894
® \.: CHECK AMOUNT: $*******290.89*
.�_ , ONE CIVIC SQUARE SAFELITE AUTOGLASS
,� CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 234395
M,�roN.�. CINCINNATI OH 45263-3197 CHECK DATE: 07/01/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 31997 01830-221017 290.89 WINDSHIELD REPLACEMEN
SAFELITE FULFILLMENT, INC CUSTOMER SERVICE CENTER 1-800-835-2257
dba: Safelite AutoGlass,: 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 01830-221017 INVOICE: 06/12/14 BD
ORDERED: 05/30/14 INSTALLED: 06/12/14
PLEASE REMIT PAYMENT TO: W.O. # : 589054 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 PH2:317-571-2546
CARMEL POLICE DEPT Acct #: 405879
3 CIVIC SQ
CARMEL IN 46032
POLICY# PO#/REF
CLAIM # LOSS LOC:
AUTH/VER: JASON LOSS DATE/CAUSE: 06/12/14
2012 DODGE GRAND CARAVAN MINI VAN ARR- MOBILE
MILEAGE: 9, 006
VIN: 2C4RDGCG7CR132048 LICENSE/ST: 339LEL IN STOCK #: 155
---------------------------------- --------------------------------------------------
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO1818 GTN 234.15 219.21 50.00 .00 .00 269.21
SOLAR-W/THIRD VISOR FRIT
1 KKD1708 19.47 9.74 .00 .00 .00 9.74
KIT R/L SIDES ONLY
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 228.95
LABOR TOTAL 61.94
SUBTOTAL 290.89
SALES TAX 0.00
P A Y T H I S A M O U N T 290.89
-
TERMS: NET 3-0
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
061214-405879-405879 00669-405879-221017
CARMEL POLICE DEPT
3 CIVIC. SQ
CARMEL IN 46032 0000000020140612742
INDIANA RETAIL TAX EXEMPT PAGE
City of
Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 31 X97
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
611012014
Safelite Auto Glass Carmel Police Department
VENDOR SHIP 3 Civic Square
TO
PO Box 633197 Can-nal, IN 46032
€
CONFiRnnn7ior�InBLA�NnKaET1, 000NTRA6C�6��I9r PAYMENT TERMS (317)571 2559 FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43.610.00
9 Each VAndshleld repiacement $290.09 $290.89
Sub Total: $290.89
y
�.+"— • fir t a t 1
{ I
Servd1l lvoiceqTO1 par
Capel Police Department
Attn: Pat Young
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $290.89
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROP Y tl-' SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. /
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE hld of Ptlice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 31 9 7 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
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
i
$290.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/rITLE AMOUNT Board Members
31997 I 01830-221017 I 43-510.00 I $290.89 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, June 26, 2014
P
Chief of Police
I Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
I
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))
06/23/14 01830-221017 windshield replacement $290.89
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