251722 11/18/15 `%'��p"F� CITY OF CARMEL, INDIANA VENDOR: 358894
® ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $**'**'"516.85•
f. �;� CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 251722
9q���TON�� CINCINNATI OH 45263-3197 CHECK DATE: 11/18/15
DEPARTMENT, ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830249712 516.85 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 01830-249712 INVOICE: 11/07/15 BD
ORDERED: 11/05/15 INSTALLED: 11/07/15
PLEASE REMIT PAYMENT TO: W.O. # : 704177 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL FIRE DEPT
CINCINNATI, OH 45263-3197 2 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032-0000
PH1:317-664-0958 PH2:
CARMEL FIRE DEPT Acct #: 160295
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# : PO#/REF
CLAIM # : LOSS LOC:
AUTH/VER: BOB LOSS DATE/CAUSE: 11/07/15
--20-15--FORD--- EXPLORER- 4-DOOR UTILCONVNATE _- - ARR: -MOBILE
MILEAGE: 2
VIN: 1FM5K8ARXFGC41183 LICENSE/ST: NA IN STOCK #: 421
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QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO1843 GGY 299.83 246.64 50.00 .00 .00 296.64
SOLAR-W/THIRD VISOR FRIT-ACOUSTIC INTERL
1 BB5Z 7803136 AB 188.43 89.00 .00 .00 .00 89.00
RIGHT OUTER
1 BB5Z 7803137 AB 188.43 89.00 .00 .00 .00 89.00
LEFT OUTER
1 PCK-1843-11 48.61 24.31 .00 .00 .00 24.31
KIT 16PCS
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 448.95
LABOR TOTAL 67.90
SUB-TOTAL 516.85
SALES TAX 0.00
PAY T H I S AMOUNT 516.85
TERMS: NET 3.0
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ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
110715-160295-160295 00513-160295-249712
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032 20151107 0000000020151107742
VOUCHER NO. WARRANT NO.
ALLOWED 20
Safelite Auto Glass
IN SUM OF$
P.O. Box 633197
Cincinnati, OH 45263
$516.85
I
i
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
i
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 01830-249712 43-510.00 $516.85 1 hereby certify that the attached invoice(s), or
i
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
NOV 6 2015
i Or) J, 4%tA/,�tl
Fire Chief
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))
01830-249712 1183 $516.85
1 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