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HomeMy WebLinkAbout317344 10/11/2017 ��'`'• CITY OF CARMEL, INDIANA VENDOR: 358894 >`. CHECK AMOUNT: $'*******84.89* ONE CIVIC SQUARE SAFELITE FULFILLMENT INC CHECK NUMBER: 317344 CARMEL, INDIANA 46032 CBOX 633197 ELI ,' •,r°. CNCINNATI OH 45263-3197 CHECK DATE: 10/11/17 MlrpN cp. DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTREPAIR PARTS ION 2201 4237000 84.89 / g -u « < < > m O 2 $ \ i o w # 2 ? r k n # D / x % 2 cr\ 0 / / q % CL < k ? \ \ k O 7 0 0 ® # F w CD§ k# / k / C -0 \ / ® o \ z } > k3 / / R § & 0 2 m 7 \ ® J \ ° d Z z z < > - . 0 | / � / /CD E i ; R r- m 0 ` � c 0 ® CD c » FL \ } \ / ƒ n § o x 2 7 m _ E \ } ; R f I f a m / 9 ƒ / \ § c - _ \ \ § 7 % % \ \ w E \ ° k k 0 A » C - � k \ a \ \ / a E f - a ƒ § % & § ) [ k\ © / m o , 5 «; R \ < - CL# w m \ [ cr mOL 0 7 2CD # \ �® P \E k \ C0 � 4 C a - zQ k E 7 N ° 2 m L J \ C o � / ^ $ CL ( N k 3 / J | cr 2 � T O e � f D }f / \ $ C/ K co c \ \ CL2 / \ � 0 } j E \ \ O E ¥ 2 4 \ CD C & ® & _ U) � G CD 0 C k m CD n _ 0 / j \ / CL CD M 0 CD n CL CD Rt ] C E C CL > \ \ § 699 a 0 (DZ ° \ SAFELITE FULFILLMENT,INC. l000' CUSTOMER SERVICE CENTER 1-800-835-2257 Safe/ite. AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING PAYMENT OF THIS INVOICE: 1-800-835-2092 INVOICE 01830-290214 INVOICE: 09/29/17 BD ORDERED: 09/27/17 INSTALLED: 09/29/17 PLEASE REMIT PAYMENT TO: W.O. # : 864790 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 PH1:317-691-6725 PH2: CARMEL, CITY OF Acct #: 062398 3400 W 131 ST WESTFIELD IN 46074 POLICY# PO#/REF CLAIM # 1 LOSS LOC: AUTH/VER: JIM LOSS DATE/CAUSE: 09/29/17 2016 FORD F SERIES F250 2 DOOR STANANANREWTIONA ARR: MOBILE MILEAGE: 1 VIN: 1FTBF2B63GED14971 LICENSE/ST: 39910 IN STOCK #: 1 QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION 1 MWSREPAIR .01 .00 69.95 .00 .00 69.95 MOBILE WINDSHIELD REPAIR 1 SUPPLIES-REPAIR 4.99 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 LABOR TOTAL 79.90 SUB-TOTAL 84.89 SALES 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 STORE LIC #: SAFELITE TAX ID #: 36-4523816 092817-062398-062398 00590-062398-290214 CARMEL, CITY OF 3400 W 131 ST WESTFIELD IN 46074 20170929 0000000020170929742