HomeMy WebLinkAbout252118 12/02/15 Coq
CITY OF CARMEL, INDIANA VENDOR: 358894
® it ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $**.....196.85`
s. ?^ CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 252118
94j'lON�°� CINCINNATI OH 45263-3197 CHECK DATE: 12/02/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 706394 196.85 AUTO REPAIR & MAINTEN
SAFELITE FULFILLMENT,INC.
CUSTOMER SERVICE CENTER 1-800-835-2257
Safelife.
AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-250210 INVOICE: 11/17/15 BD
ORDERED: 11/16/15 INSTALLED: 11/17/15
PLEASE REMIT PAYMENT TO: W.O. # : 706394 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL, CITY OF
CINCINNATI, OH 45263-3197 3400 W 131 ST
PLEASE WRITE INVOICE NUMBER ON CHECK WESTFIELD IN 46074-0000
PH1:317-733-2001 PH2 :
CARMEL, CITY OF Acct #: 062398
3400 W 131 ST
WESTFIELD IN 46074
POLICY# PO#/REF -
CLAIM # LOSS LOC:
AUTH/VER: JAMES LOSS DATE/CAUSE: 11/17/15
2004 GMC SIERRA K2500 HD 4 DOOR CREWR EXTEREW ARR: MOBILE
MILEAGE: 2
VIN: 1GTHK23U84F251570 LICENSE/ST: NA IN STOCK #: TRUCKI6
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DB09484 YPY 168.77 128.95 50.00 .00 .00 178.95
SOLAR-STATIONARY
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 128.95
LABOR TOTAL 67.90
SUB-TOTAL 196.85
SALES TAX 0.00
P A Y T H I S A M O U N T 196.85
TERMS:
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
111615-062398-062398 00590-062398-250210
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20151117 0000000020151117742
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))
11/17/15 706394 $196.85
I
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
VOUCHER NO. WARRANT NO.
Safelite Fulfillment, Inc. ALLOWED 20
IN SUM OF $
4625 W. 86th Street Suite 100
Indianapolis, IN 46268
$196.85
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 I 706394 I 43-510.001 $196.85 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
Friday`, Novi b &2015
All
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EStrteetCComni i'ssib1f6r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund