HomeMy WebLinkAbout236673 09/03/14 4�1 F+qy@
CITY OF CARMEL, INDIANA VENDOR: 358894
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $*******159.95*
CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 236673
CINCINNATI OH 45263-3197 CHECK DATE: 09/03/14
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 159.95 AUTO REPAIR & MAINTEN
Safelife.AutoGlass
SAFELITE AUTOGLASS Date&Time: 08/27/14 09:09AM
4625 W.86TH ST.,#100
INDIANAPOLIS,IN 46268
**SERVICE QUESTIONS**
**CALL 317-614-4200**
Customer: Home Phone: 317-571-2600
Bob Work Phone: 317-664-0958
Service Phone: 317-664-0958
5032 E 131 ST ST Work Order#: 01830_608150
CARMEL,IN 46032 (01830_608150)
Year . Make -:Model
2011 SEAGRAVES MARAUDER
License Styyle - Stock/Unit#
UNK FIRE TRUCK E44
Mileage VIN
123456 1F9E228T7BCST2030
Purchase-Order#
E44
ListSelling Flat
Qty Part Price Price Labor Kit MTRL
1 LABOR 0.00 0.00 150.00 0.00 0.00
1 FUEL SURCHARGE 3.99 0.00 9.95 0.00 0.00
Technician Name Tech ID
Anthony Cashman 1830=935
Technician Note:
VEHICLE PRE-INSPECTION
Part Subtotal: 0.00
Flat Labor Subtotal: 159 .95
Subtotal: 159.95
Sales Tax: 0 .00
Total: 15.8: 95
Deductible: - 0 .00
Promo Discount: 0 . 00
Amount to Collect: 0 .00
Estimate:$159.95. 1 authorize Safellte AutoGlass to provide the
above-referenced goods and services and to Install or repair glass
and related parts that are manufactured by Safellte or another
aftermarket manufacturer. Subject to completion of the work,I
assign to Safellte any claim that I have under my Insurance policy
to recover,and authorize my Insurance company to pay Safellte the
balance due. If said amount Is not paid In full by my Insurance
company,I agree to pay any unpaid balance. If paying by check,and
your check Is unpaid for Insufficient or uncollected funds,we may
electronically debit your account for the principle check amount and .
a service fee as allowable by law. You have the right to select the
repair facility of your choice. I have read and understand the
Adhesive Cure Time Caution on the attached form. In most cases,the
approximate length of time to complete the tasks detailed on this
work order Is 45 minutes to 1 hour.
Signature: Signature on file.
VOUCHER NO. WARRANT NO.
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Safelite Auto Glass ALLOWED 20
IN SUM OF$
P.O. Box 633197
Cincinnati, OH 45263
$159.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 43-510.00 $159.95 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
SEP - 2 2014
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Fire Chief
l Title
7
Cost distribution ledger classification if
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claim paid motor vehicle highway fund j
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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
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
VIN 2030 $159.95
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