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Home My WebLink About260307 06/28/16 i (9, CITY OF CARMEL, INDIANA VENDOR: 370695 ONE CIVIC SQUARE SAFECO PROCESSING CENTER CHECKAMOUNT: $*******130.26*CARMEL, INDIANA 46032 PO BOX 515097 CHECK NUMBER: 260307 LOS ANGELES CA 90051 CHECK DATE: 06/28/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 06132016 130.26 AUTO REPAIR & MAINTEN VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) SAFECO PROCESSING CENTER ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 515097 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service LOS ANGELES, CA 90051 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $130.26 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Carmel Police Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 0 43-510.00 $130.26 1 hereby certify that the attached invoice(s),or 6/22/16 0 reimbursement for overpayment of repairs to $130.26 1110 101 1110 101 car 123 bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and S\ received except 3 Wednesday,June 22,2016 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer INVOICE June 13, 2016 Bill to: Carmel Police Department 3 Civic Square Carmel, IN 46032 Claim#438086026039 I have enclosed a copy of the check that we received as payment for vehicle repairs. The actual repairs totaled $302.07 which leaves a balance of$123.67 which we are refunding to you. If you have any question please call me. Pat Young 317-571-2559 TOTAL AMOUNT DUE: $123.67 Please make check payable to: Safeco Processing Center PO Box 515097 Los Angeles, CA 90051 Date: 05/26/2016 Jqi;R ABRA HE Carmel INVOICE AUTO BODY&GLASS 503 West Carmel Drive RO#: 8183 Carmel, IN 46032 (317) 569-9884, (317)569-9885 (fax) Est: Beth Shepherd CITY OF CARMEL 14 FORD EXPLORER 4X4 POLICE Customer Pay CITY OF CARMEL Color:gray Adjustor: SHARRELL DENISE 1 CIVIC SQUARE Type: UV 4D UTV QUICK CARMEL, IN 46032 VIN: 1 FM5K8AR7EGC38112 Phone: Home: Prod Date:0114 Plate: 16701 Claim#:438086026039-201 Work: Mileage:20476 Deductible:0 Fax: Engine: 6-3.7L-FI I Loss Type: Liability P=Who Pays. I=Insurance,C=Customer Qty Type Description Part# Amount Sup Labor Op Labor Paint P # Units Units Parts Other REAR LAMPS RT Tail lamp assy 1 Body R&I 0.3 1 Parts Other REAR LAMPS LT Tail lamp assy 1 Body R&I 0.3 1 REAR BUMPER O/H rear bumper Body 1.8 1 1 Parts OEM REAR BUMPER Lower cover w/o park BB5Z17F828 196.49 Body Repl I sensors AA Parts Other REAR BUMPER RT Reflector 1 Body R&I I Parts Other REAR BUMPER R&I bumper cover Body R&I I Parts Other REAR BUMPER LT Reflector 1 Body R&I I 1 Haz Waste 'Hazardous Waste 5.00 Body I Adjustment -9.82 SubTotal 302.07 Taxes Grand Total Due from Insurance Due from Customer Sub-Total 302.07 Sub-Total 0.00 Tax 0.00 --------- --------- Total 0.00 Total Amount INVOICE #22 05/26/2016 09:47:54 AM RO#8183 ABRA HE Carmel Pagel M- 11 I� 'ara-ticet, X29'32494. A liberty Mutual Coippany `ISSUE DATEAPR 16' ' 2016 CLAIM ' N'0. 43808602`6039 CLAIMS ACCOUNTING ACS REF NO. 13A160821.796 P. O. BOX 461 POLICY NO. K01959090 ST. LOUIS, MO 63166-0461 LOSS DATE 03-17-16 ADJUSTER: SHARRELL QUICK AGENT: 58-0276 PHONE NO: 1-800-332-3226 CH INS BROKERAGE SERV CO INC CITY OF CARMEL 1 CIVIC SQUARE CARMEL IN 46032 COVERAGES PAID THIS CHECK: 430 . 69 APD AUTO PROPERTY DAMAGE ****430 . 69 TOTAL PAID THIS CHECK INSURED: TANSKY ELLEN B TANSKY, MICHAEL C CLAIMANT: CITY OF CARMEL IN PAYMENT OF : 14 FORD 3� ec� � Z 3 •b`1 pcsNT-NR CAREFULLY DETACH CHECK BEFORE DEPOSITING-RETAIN STATEMENT FOR YOUR RECORDS 1/ERIfiY7HE.AUTHENTICITXtOF;FHIS:MUI T1-TDNE'SECURiTY DOCUMENT CHECK BgCKGROUND-AREA:iCHANGf S'COLO'R"DR"ADUA#IV.;FROM TOP..TO$OTTOM.?r X94SCG-k* 004698,, ( : TheNOrthernTrustCompany `j. �� Chicago IL FSE Safeco Insurance Comparnes ta; Payebte C through Oal�rgokTenace IL.' EK DATE o 2aez P O Boz 461 4 l hcrty.�tu4u�1 Cuiitlran� APR 16, 2016 79 Sa1nt:Lou1§ MO 63166=0461 e code so seo Claim No 13A160821746 VoucherNo 1070598 S 9E*,4-k'4 3 0 6 9 VOID IF NOT PRESENTED WITHIN SIX ... - MONTHS OF ISSUE DATE OF CHECK PAY ;FOUR :HU.NDRED':: TH:IRTY`.DOL:LARS AND 69/10:D- �- -- '——=——————————-——————— TOTHE ..:ORDER CITY OF CARMEL OF 1 C:IVIC... SQU.A.RE CARMEL IN: .46032 - .: TWO R REQUIRED I SI --TU ESR F'A UNT EXCEEDS$500,060 -: 12932494118 .100 L 9 2 38 2131:0 30 1 S 66 50uff .. THE ORIGINAL'DOCUMENT HAS A REFLECTIVE'WATERMARK ON THE BACK.:HOLD AT AN•ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENT.