HomeMy WebLinkAbout236018 08/13/14 58894
CITY OF CARMEL, INDIANA VENDOR: 3
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $*******232.85*
CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 236018
CINCINNATI OH 45263-3197 CHECK DATE: 08/13/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 01830-603316 232.85 EQUIPMENT REPAIRS & M
Safe lAutoGlass
SAFELITE AUTOGLASS Date&Time: 08/04/14 02:02PM
4625 W.86TH ST.,#100
INDIANAPOLIS, IN 46268
**SERVICE QUESTIONS**
**CALL 317-614-4200**
Customer: Home Phone: 317-571-2255
robert Work Phone:
Service Phone: 317-501-2146
12120 Brookshire Pkwy Work Order#: 01830_603316
Carmel, IN 46033 (01830_603316)
Year Make Model
1992 OLLZSMOBILE CUTLASS CIERA
License Style Stock/Unit#
649ACZ 4 DOOR SEDAN
Mileage VIN
138983 1G3AL54N8N6360815
Purchase-Order#
Liat Sal IIng Flat
QtyPart Price Price Labor Kit MTRL
1 DWO1005 GBNOEE 184.92 154.80 50.00 0.00 0.00
1FLEXIMOLD 20.29 10.15 0.00 0.00 0.00
1 DISPOSAL FEE 4.95 0.00 7.95 0.00 0.00
1 FUEL SURCHARGE 3.99 0.00 9.95 0.00 0.00
Technician Name Tech ID
Michael Mahaney 1830-757
Technician Note:
VEHICLE PRE-INSPECTION
Part Subtotal: 164 . 95
Flat Labor Subtotal: 67 . 90
Subtotal: 232. 8 5
Sales Tax: 0. 00
Total: 232 . 85
Deductible: 0 . 00
Promo Discount: 0. 00
Amount to Collect: 0.00
Estimate: $232.85. 1 authorize Safellte AutoGiass to provide the
above-referenced goods and services and to Install or repair glass
and related parts that are manufactured by Safelite or another
aftermarket manufacturer. Subject to completion of the work, I
assign to Safelite any claim that I have under my Insurance policy
to recover,and authorize my Insurance company t0 pay Safelite the
balance due. If said amount Is not paid in full by my Insurance
company, I agree to pay any unpaid balance. If paying by check,and
your check Is unpaid for Insufficient or uncollected funds,we may
electronically debit your account for the principle check amount and
a service fee as allowable by law. You have the right to select the
repair facility of your choice. I have read and understand the
Adhesive Cure Time Caution on the attached form. In most cases,the
approximate length of time to complete the tasks detailed on this
work order Is 45 minutes to 1 hour.
Signature: Signature on file.
Safe to drive vehicle after: 1 hour
VOUCHER NO. WARRANT NO.
ALLOWED 20
Safelite Autoglass
IN SUM OF $
4625 W. 86th St.
Indianapolis, IN 46268
$232.85
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 01830-603316 I 43-500.00 I $232.85 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
Wednesday, August 06, 2014
Director, Brookshir-A#olf Club
Title
i
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.
I
Terms
Date Due
I
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07/04/14 I 01830-603316 I Repair Windshield I $232.85
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