252393 1 2/08/1 5 r_
y " CITY OF CARMEL, INDIANA VENDOR: 358894
`' ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $"*"****332.85*
Coq
CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 252393
9M�TON�°` CINCINNATI OH 45263-3197 CHECK DATE: 12/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 1830250605 332.85 OTHER EXPENSES
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 01830-250605 INVOICE: 11/24/15 BD
ORDERED: 11/23/15 INSTALLED: 11/24/15
PLEASE REMIT PAYMENT TO: W.O. # : 707642 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL, CITY OF
CINCINNATI, OH 45263-3197 WATER DISTRIBUTION
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46074-0000
PH1:317-733-2844 PH2:
CARMEL, CITY OF Acct #: 371835
WATER DISTRIBUTION
3450 W 131ST
CARMEL IN 46074
POLICY# : PO#/REF
CLAIM # : LOSS LOC:
AUTH/VER: JOHN LOSS DATE/CAUSE: 11/24/15
-------------------------------------------------------------------------------
2006 FORD, ESCAPE HYBRID 4 DOOR UTILANAATIONA ARR:--MOBILE
MILEAGE: 111
VIN: lFMCU96H96KA26088 LICENSE/ST: 67558 IN STOCK #: 92
- - ----- -- - - - - - - - - - - - -- - - - - - - -- - - - - - - - - -- ---- -- - - - - - -- - - - - ----- - -- --- --- - - - - - - - - - -- - -
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DB10273 YPY 303.61 264.95 50.00 .00 .00 314.95
HEATED-SOLAR-8 HOLE
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
�N
PART TOTAL 264.95
LABOR TOTAL 67.90
SUBTOTAL 332.85
SALES TAX 0.00
P A Y T H I S A M O U N T 332.85
TERMS: NET 30
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
112415-371835-371835 00609-371835-250605
t '
' CARMEL, CITY OF
WATER DISTRIBUTION
3450 W 131ST 0000000020151124742
CARMEL IN 46074
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee _
358894
SAFELITE FULFILLMENT INC Purchase Order No.
PO BOX 633197 Terms
CINCINNATI, OH 45263-3197 Due Date 12/4/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/4/2015 1830250605 $325.85
1 hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance withIC5-11-10-1.6
Date Officer
VOUCHER # 153762 WARRANT # ALLOWED
358894 IN SUM OF $
SAFELITE FULFILLMENT INC
PO BOX 633197
CINCINNATI, OH 45263-3197
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1830250605 01-6500-07
�3a_ gs
Voucher Total �.
Cost distribution ledger classification if
claim paid under vehicle highway fund