HomeMy WebLinkAbout256514 03/15/16 a`( �'p''� CITY OF CARMEL, INDIANA VENDOR: 358894
= CHECK AMOUNT: $*******222.85*
��• ONE CIVIC SQUARE SAFELITE AUTOGLASS
r_ +'; CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 256514
M,��oN�o.� CINCINNATI OH 45263-3197 CHECK DATE: 03/15/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4237000 030816 222.85 REPAIR PARTS
SAFELITE FULFILLMENT,INC.
Safelile. CUSTOMER SERVICE CENTER 1-800-835-2257
AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-256202 INVOICE: 03/08/16 BD
ORDERED: 03/04/16 INSTALLED: 03/08/16
PLEASE REMIT PAYMENT TO: W.O. # : 729957 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: JIM LOSS DATE/CAUSE: 03/08/16
1998 CHEVROLET PICKUP K2500 2 DOOR STANR UTILNV ARR: MOBILE
MILEAGE: 123,456
VIN: 1GCGK24R1WZ271778 LICENSE/ST: UNK IN STOCK #: 211
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DW01217 GBY 197.97 154.95 50.00 .00 .00 204.95
SOLAR-ENCAP-W/BRACKET
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 154.95
LABOR TOTAL 67.90
SUB-TOTAL 222.85
SALES TAX 0.00
P A Y T H I S A M 0 U N T 222.85
TERMS:
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
030716-062398-062398 00590-062398-256202
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20160308 0000000020160308742
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s) or bill(s))
03/08/16 01830-256202 $222.85
2201 201
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