HomeMy WebLinkAbout304126 10/10/16 (9,
CITY OF CARMEL, INDIANA VENDOR: 358894 ..#.�..ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: S 84.89CARMEL, INDIANA 46032 PO Box 633197 CHECK NUMBER: 304126
CINCINNATI OH 45263-3197 CHECK DATE: 10/10/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 01830268791 84.89 AUTO REPAIR & MAINTEN
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
SAFELITE AUTOGLASS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 633197 IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CINCINNATI, OH 45263-3197 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$84.89 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
768601 43-510.00 $84.89 1 hereby certify that the attached invoice(s),or 9/28/16 768601 windshield repair $84.89
1110 101 1110 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, October 05,2016
Tim Green
Chief of Police
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
SAFELITE FU LFIVLMENTi".lK
CUSTOMER SERVICE CENTER 1-800-835-2257
Aut6Glagq� IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-268791 INVOICE: 09/28/16 BD
ORDERED: 08/04/16 INSTALLED: 09/28/16
PLEASE REMIT PAYMENT TO: W.O. # : 768601 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL POLICE DEPT
CINCINNATI, OH 45263-3197 3 CIVIC SQ
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032-0000
PH1:317-571-2546 PH2:
CARMEL POLICE DEPT Acct #: 405879
3 CIVIC SQ
CARMEL IN 46032
POLICY# PO#/REF : 34147
CLAIM # 74 LOSS LOC:
AUTH/VER: JASON LOSS DATE/CAUSE: 09/28/16
2016 FORD EXPLORER 4 DOOR UTILOR EXTE AREWTIONA ARR: MOBILE
MILEAGE: 3,673
VIN: 1FM5K8AR3GGD05601 LICENSE/ST: 18445 IN STOCK #: 74
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 MWSREPAIR .0l_ .00 69.95 .00 .00 69.95
MOBILE WINDSHIELD.jREPAIR
1 SUPPLIES-REPAIR 4:'.99>t' 4.99 .00 .00 .00 4.99
REPAIR SUPPLIES`�'=;:.•'
1 FUEL SURCHARGE 3.,99 _00 9.95 .00 .00 9.95
FUEL SURCHARGE
'.'',%,/PART TOTAL 4.99
BOR TOTAL 79.90
S;UB,'TOTAL 84.89
SALE$,TAX 0.00
P A Y T H I S A M 0 U N T 84.89
TERMS:
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
092716-405879-405879 00669-405879-268791
CARMEL POLICE DEPT
3 CIVIC SQ
CARMEL IN 46032 0000000020160928742