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Home My WebLink About258609 05/13/16 (9* CITY OF CARMEL, INDIANA VENDOR: 370583 ONE CIVIC SQUARE AMERICAN FAMILY MUTUAL INSURANAIM AMOUNT: S""***118.61 CARMEL, INDIANA 46032 6000 AMERICAN PKWY CHECK NUMBER: 258609 MADISON WI 53783 CHECK DATE: 05/13/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 051016 118.61 AUTO REPAIR & MAINTEN VOUCHER NO. WARRANT NO. ALLOWED 20 AMERICAN FAMILY MUTUAL INSURANCE CO 6000 AMERICAN PKWY IN SUM OF$ MADISON, WI 53783 $118.61 ON ACCOUNT OF APPROPRIATION FOR Carmel Police PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members 0 j 43-510.00 j $118.61 1 hereby certify that the attached invoice(s), or 1110 O5(('' LLO 101 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, May 10,2016 i �, 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 Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 05/10/16 0 reimbursement for over payment on car 120.Claim#00-345149480- $118.61 1110 101 1535 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 20Clerk-Treasurer INVOICE May 10, 2016 Carmel Police Department 3 Civic Square Carmel, IN 46032 Claim# 00-345-149480-1535 Policy#25-299421-02 I have enclosed a copy of the check that we received as payment for vehicle repairs. The actual repairs totaled $1,818.42 which leaves abalance of$118.61 which I am refunding to you. If you have any questions please call me. Pat Young 317-571-2559 TOTAL AMOUNT DUE: $118.61 Please make check payable to: American Family Insurance Group 6000 American Pkwy Madison,WI 53783-0001 AMERICAN FAMILY INSURANCE GROUP AMERICAN FAMILY 6000 AMERICAN PKWY _ MADISON WI 53783-0001 A +0000001 CLM-SCAN CARMEL POLICE DEPARTMENT 3 CIVIC SQ CARMEL IN 46032-2584 AMERICAN FAMILY.INSURANCE GROUP EXPLANATION OF REMITTANCE CLAIM 00-345-149480-1535 NUMBER 0003391190 TIN xxxx xxxx TYPE Loss Claim PRODUCER 046061 IN PAYMENT OF A LOSS OCCURRING ON 03/02/2016 PAYMENT INFORMATION DETAIL CARMEL POLICE DEPARTMENT $1,937.03 PROPERTY DAMAGE LIABILITY COMMENTS payment for subro claim for damage to unit #120 DETACH AND REFER TO THIS STUB IF CORRESPONDING ON THIS CLAIM. IF QUESTIONS CALL 1-800-MYAMFAM. U-31'.;43 e e • e• a •• • • • •• C-2379' AMERICAN FAMILY 1NSURANCE GROUP,MADISON,WISCONSIN 775$ U S BAN WAtIONk-AS�,SOGIATI�QI�I WWUV USBA�11(r("Qly! nz ah *,WSAU.WISCONSIN' t ;' I,a , p. flQ0 �9 f 90x: �PVF10E � ASD';�E� !p, o rCLA1M'?�11Jr,Qb-3�#` ifI�OLICYNO:2E 2$421-02 DATE 03/ 1/20 5 PAYTOTHE CARMEL POLICE DB0R7 fFp �a AMOUNT $****1,937.03 Opp"OF �r � 'a s " •• �I �1ldlv 11 III 4II II ' PAY ONE TIiQUSAND NINE FII7NDR ' II�2T'l� &kUNI /�p0', DOL, ARS INSURED' WAGNER, PATRICK D �,4j i ru '1' 4 CHIEEEINihd FFICER EgSURER .-" ". '. i 'l, t•. 711 ,`" ' I I .. ,• - POLICY ISSUED BY AMERICAN FAM4).YIIIUTUAL'ISUR�l1�1bEClIVIP'ANY PRESIDENT 113000339119011' 1:07591 L6031: L8 2 380 18 5 5 6 711' Date: 05/05/2016 9 ABRA HE Carmel INVOICE`-- 503 West Carmel Drive RM BODY&GLASS Carmel, IN 46032 RO#: 7815 317 569-9884, 31 569-9885 fax Est:BETH SHEPHERD CARMEL POLICE DEPARTMENT 12 Chevrolet Impala American Family Insurance CARMEL POLICE Color:WHITE DEPARTMENT Type: Police 4 DR Sedan Adjustor: 3 CIVIC SQ VIN:2G1 WD5E37C1285893 Phone: CARMEL, IN 46032-2584 Prod Date:0412 Plate:IN 7228 Claim#:00345149480-1 C Home: 317-571-2523 Mileage: 103542 Deductible:0 Work: Engine:6 cyl Gas Flex Fuel Loss Type: Liability Fax: P= ho Pa s? I=Insurance,C=Customer Qty Type Description Part# Amount Sup Labor Op Labor Paint P # Units Units Parts Other Front Door R&I LT Body Addl 1.1 1 Door Shell,Front LT Body Rpr 1.0 1 Door Shell,Front LT A Rein 3.4 1 Pnl,Front Door Outer LT Body Rpr 8.0 1 Pnl,Front Door Outer LT A Ref I Pnl,lnner Door Trim LT Body R&I I Mldg,Front Door Belt LT Body R&I 0.6 1 1 Parts OEM Mldg,Front Door Side LT 19257892 148.42 Body Repl 0.2 1 MIdg,Front Door Side LTA Ref 0.5 1 Mirror,Outer R/C LT Body R&I I Handle,Front Door Otr LT Body R&I 0.2 1 Parts Other Rear Door R&I LT Body Addl 1.1 1 Door Shell,Rear LT Body Rpr 1.0 1 Door Shell,Rear LT A Refn 2.2 1 Pnl,Rear Door Outer LT Body Rpr 8.0 1 Pnl,Rear Door Outer LT A Rein I MIdg,Rear Door Belt LT Body R&I 0.2 1 Mldg,Rear Door Side LT Body Rpr 1.0 1 MIdg,Rear Door Side LTA Rein 0.5 1 MIdg,Rear Door Side LT B Body R&I 0.2 1 Pnl,lnner Door Trim LT A Body R&I I Handle,RR Door Outer LT Body R&I 0.2 1 Remove decal Body Rpr 1.0 1 Clean and retape Body Rpr 0.3 1 Remove decal rear door Body Rpr 1.0 1 Parts Other Clean and Re tape Mldg Body Addl 0.3 1 Pnt/Mat MISC Paint&Materials 198.00 I SubTotal Taxes Gran o�takri� ---�.--- Due from Insurance Due from Customer Sub-Total 1,818.42 Sub-Total 0.00 Tax Tax 0.00 Total 4q@*Pm@7 Total 0.00 Total Amount INVOICE #22 05/05/2016 03:40:42 PM RO#7815 ABRA HE Carmel Pagel 1 I ABRA Carmel, Formerly Hubler Workfile ID: 2b0784ee Federal ID: 41-1484683 s Express Right the First Tiime...On Time iWM BODY&GLASS 503 West Carmel Drive,Carmel, IN 46032 Phone: (317)569-9884 FAX: (317)569-9885 Preliminary Est�mate � , Customer:UNIT 120,CARMELPD Sob Number: Written By:Timothy George Insured: UNIT"120,CARMELPD Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 09 Left T-Bone(Left Side) Owner: Inspection Location: Insurance Company: UNIT 120,CARMELPD ARRA Carmel,Formerly Hubler Express CUSTOMER PAY 503 West Carmel Drive Carmel,IN 46032 Repair Facility (317)569-9884 Business VEHICLE Year: 2012 Body Style: 4D SED VIN: 2G1WD5E37C1285893 Mileage In: 102174 Make: CHEV Engine: 6-3.6L-FI License: 7228 Mileage Out: Model: IMPALA POLICE Production Date: 4/2012 State: IN Vehicle Out: Color: WHITE Int: Condition: Job#: TRANSMISSION Body Side Moldings FM Radio SEATS Automatic Transmission Tinted Glass Stereo Bucket Seats Overdrive Wood Interior Trim Search/Seek WHEELS POWER CONVENIENCE CD Player Styled Steel Wheels Power Steering Air Conditioning Auxiliary Audio Connection PAINT Power Brakes Intermittent Wipers SAFETY Clear Coat Paint Power Windows Tilt Wheel Drivers Side Air Bag OTHER Power Lodes Cruise Control Passenger Air Bag Traction Control Power Mirrors Rear Defogger Anti-Lock Brakes(4) Stability Control Power Driver Seat Keyless Entry 4 Wheel Disc Brakes Power Trunk/Gate Release DECOR RADIO Front Side Impact Air Bags Dual Mirrors AM Radio Head/Curtain Air Bags 3/2/2016 2:16:30 PM 307327 Page 1 Preliminary Estimate Customer: UNIT 120,CARMELPD fob Number: Vehicle:2012 CHEV IMPALA POLICE 41)SED 6-3.6L-FI WHrrr: ESTIMATE TOTALS Category Basis Rate cost$ Parts 156.23 Body Labor 24.1 hrs @ $48.00/hr 1,156.80 Paint Labor 7.7 hrs @ $48.00/hr 369.60 Paint Supplies 7.7 hrs @ $32.00/hr 246.40 Miscellaneous Subtotal LOW Sales Tax $405.63 @ 7.0000% Grand Total Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY MyPriceUnk Estimate ID: 134371664547823616 A PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD AN INSURER FILES A STATEMENT OF CLAIM CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION COMMITS A FELONY, 3/2/2016 2:16:30 PM 307327 Page 3