HomeMy WebLinkAbout258022 04/26/16 ,� CITY OF CARMEL, INDIANA VENDOR: 358894
® 1 ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $*******216.85*
s ?? CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 258022
_9��fori�°' CINCINNATI OH 45263-3197 CHECK DATE: 04/26/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 830852 216.85 AUTO REPAIR & MAINTEN
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))
04/14/16 830852 $216.85
2201 201
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
SAFELITE AUTOGLASS
PO BOX 633197 C IN SUM OF$
CINCINNATI, OH 45263-3197
$216.85
ON ACCOUNT OF APPROPRIATION FOR
Street Department
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Member
830852 I 43-510.00 I $216.85 1 hereby certify that the attached invoice(s), or
2201 201
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
Tuesday, April 19, 2016
Street Commisslonar
Cost distribution ledger classification if
claim paid motor vehicle highway fund
SAFELITE FULFILLMENT,INC.
Safelite. CUSTOMER SERVICE CENTER 1-800-835-2257
AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-258528 INVOICE: 04/14/16 BD
ORDERED: 04/12/16 INSTALLED: 04/14/16
PLEASE REMIT PAYMENT TO: W.O. # : 739480 REFERRAL#: 830852
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 JAMES
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# JAMES PO#/REF : JAMES
CLAIM # LOSS LOC:
AUTH/VER: JAMES LOSS DATE/CAUSE:
2006 FORD F SERIES F550 2 DOOR STANXTEDAEWTANONA ARR: MOBILE
MILEAGE: 91,711
VIN: 1FDAF57P56ED35491 LICENSE/ST: 70611 IN STOCK #: JAMES
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DB09333 GTN 160.00 148.95 50.00 .00 .00 198.95
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 148.95
LABOR TOTAL 67.90
SUB-TOTAL 216.85
SALES. TAX 0.00
P A Y T H I S A M 0 U N T 216.85
TERMS:
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/C
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
041316-0,62398-062398 00590-062398-258528
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20160414 0000000020160414742