HomeMy WebLinkAbout324983 05/09/18 ,C.Iq
CITY OF CARMEL, INDIANA VENDOR: 370613
j; ® r ONE CIVIC SQUARE EAN SERVICES, LLC CHECK AMOUNT: S"'"'5,617.10'
a�; CARMEL, INDIANA 46032 PO BOX 402383 CHECK NUMBER: 324983
v ATLANTA GA 30384-2383 CHECK DATE: 05/09/18
�TON.Gp.
k DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
911 4352600 445809784 853.30 AUTOMOBILE LEASE
911 4352600 446001089 853.30 AUTOMOBILE LEASE
1110 4352600 4460586;11 ;t , 853.30 AUTOMOBILE LEASE
1110 4352600 446086489 853.30 AUTOMOBILE LEASE
911 4352600 446087962,,, 853.30 AUTOMOBILE LEASE
1110 4352600 446105005' 655.01 AUTOMOBILE LEASE
1110 4352600 446430886 198.29 AUTOMOBILE LEASE
210 4357000 RA639355850 497.30 TRAINING SEMINARS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370613 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
EAN SERVICES, LLC IN SUM OF$ CITY OF CARMEL
PO BOX 402383 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.
ATLANTA, GA 30384-2383
Payee
$2,559.90
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
446058611 43-526.00 $853.30 1 hereby certify that the attached invoice(s),or 4/30/18 446058611 April-Meyer $853.30
1110 101 1110 101
446086489 43-526.00 $853.30 bill(s)is(are)true and correct and that the 4/30/18. 446086489 April-Locke $853.30
1110 101 materials or services itemized thereon for 1110 101
446105005 43-526.00 $655.01 4/30/18 446105005 April-Schalburg $655.01
1110 101 which charge is made were ordered and 1110 101
446430886 43-526.00 $198.29 received except 4/30/18 446430886 April-Schalburg $198.29
1110 101 1 1110 101
Tuesday, May 1,2018
Jim Barlow
Chief
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
Na ' aRental Agreement#446058611
s ® Invoice#40053207456
Renter Information Trip Information
Renter Name Pickup Return
RYAN MEYER n Fri,Mar 23 2018 (D 10:52 A.M. n Sun,Apr 22 2018 Q 10:52 A.M.
-- CARMEL E 116TH ST CARMEL E 116TH ST
Renter Address 1748 E 116TH ST 1748 E 116TH ST
3 CIVIC SQUARE CARMEL,IN 46032 CARMEL,IN 46032
TBD USA USA
CARMEL,IN 46032
USA
Contract Rental Charges
CARMEL POLICE Rental Rate Time&Distance 1 Month at$899.99/Month $899.99
Add-Ons Discount(5.00%) -$45.00
Vehicle Information -------- ------- -------------- -
Mileage Unlimited Mileage Included
License#: Taxes and Fees Incorrect Product Code Rate-cr(-$4.99/Rental) -$4.99
State/Province: Vehicle License Fee Rec 0.11/day($0.11/Day) $3.30
—^— Sales Tax(7.00%) $
Vehicle Class Driven
Premium Special 4-Door/Automatic/Air Total $913.03
Vehicle Class Charged (Subject to audit)
Full Size 4-Door/AutomatietAir Amount charged to BUSINESS ACCOUNT-APPLICANT C
- ------ Amount Due -
— -
OdometerMileage/Kilometers - - -- -- -- -------- -_
Starting:12,258 Ending:13,214
Total:956
Thank you for renting with
National Car Rental
We appreciate your business!
This email was automatically generated
from an unattended mailbox,so please do
not reply to this e-mail.
If you have any questions about your
rental,please view our Frequently Asked
Questions or send us a secured message
by visiting our Support Center
`N ®a nal Rental Agreement#446086489
Invoice#40053208569
Renter Information Trip Information
Renter Name Pickup Return
ROBERT LOCKE b Sat,Mar 24 2018 0 10:00 A.M. n Mon,Apr 23 2018 0 10:00 A.M.
— CARMEL E 116TH ST CARMEL E 116TH ST
Renter Address 1748 E 116TH ST 1748 E 116TH ST
539 CEDAR LAKE CT CARMEL,IN 46032 CARMEL,IN 46032
CARMEL,IN 46032 USA USA
USA
Contract
CARMEL POLICE Rental Charges
- --- Rental Rate Time&Distance 1 Month at$899.99!Month $899,99
Rental Credits
7 credits have been awarded for this rental Add-Ons Discount(5.00%) -$45.00
Mileage Unlimited Mileage Included
Vehicle Information
4X4 SUPERCREW CAB STYLESIDE 5.5 Taxes and Fees Sales Tax(7.00%)
FT.
Incorrect Product Code Rate-cr(-$4.99/Rental) -$4.99
License#:FL299AAN
Vehicle License Fee Rec 0.11/day($0.11/Day) $3.30
State/Province:IN Total $913.03
Vehicle Class Driven (Subject to audit)
Pickup 4-Door/Automatic/Air Amount charged to BUSINESS ACCOUNT-APPLICANT
---- -Due-----
--- -- ------ - - ----=----- --------
Vehicle Class Charged Amount �� -73Full Size 4-Door/Automatic/Air p,FMI07 S-9
Odometer Mileage/Kilometers �-
Starting:3,100 Ending:4,146
Total:1,046
Thank you for renting with
National Car Rental
We appreciate your businessl
This email was automatically generated
from an unattended mailbox,so please do
not reply to this e-mail.
If you have any questions about your
rental,please view our Frequently Asked
Questions or send us a secured message
by visiting our Support Center
o *nal Rental Agreement#446430886
Invoice#40053237023
Renter Information Trip Information
Renter Name Pickup Return
RANDY SCHALBURG 6 Mon,Mar 26 2018 0 12:00 P.M. 6 Wed,Apr 25 2018 12:00 P.M.
Start Charges CARMEL E 116TH ST
Renter Address Thu,Apr 19 2018 (D 5:01 P.M. 1748 E 116TH ST
CARMEL E 116TH ST CARMEL,IN 46032
USA
1748 E 116TH ST USA
CARMEL,IN 46032
Contract USA
CARMEL POLICE
Rental Charges
Vehicle Information Rental Rate Time&Distance1 Week at$200.00/Week $200.00
Add-Ons Discount(5.00%) -$10.00
License#: Mileage Unlimited Mileage Included
State/Province:
Taxes and Fees Vehicle License Fee Rec 0.11/day($0.11/Day) $0.66
Vehicle Class Driven Rental Excise Tax 4 Pct(4.00%) $7.63
Total $198.29
Vehicle Class Charged (Subject to audit)
Full Size 4-Door/Automatic/Air Amount charged to BUSINESS ACCOUNT-APPLICANT
Odometer Mileage/Kilometers Amount Due
Starting:12,998 Ending:13,075
Total:77
Thank you for renting with
National Car Rental
We appreciate your business!
This email was automatically generated
from an unattended mailbox,so please do
not reply to this e-mail.
If you have any questions about your
rental,please view our Frequently Asked
Questions or send us a secured message
by visiting our Support Center
YY�'N
• / e V S. 445105005 Ret
r Rental Locati- Rarte-- ::ane RP-N7Y SCP' _PCI
CARKEZ, E _ 3 ST 25-EVAR-2914.:2e00 F_1
-748 EAZ, 1:6•IH ST Itd 46002
CL CjRT1EL IN 46032-3 Pkcre 1311584490:1
CARMEL POLICCE
O Contract :D CITY OF
O Rer-urr_ Locacior.
100 CARVEL a 116TE ST :9-APR-20:P 05:x1 F[•]
M
r0
Charges RV
O
r
vehicle k 300 TIME & Dys _6.1c 85.66 DJET kp; E 3 [Seeks
CM Cl231.99 695.97 k
Class h �Isr.L�rc=
N ass Driven cen _WLIKI^3D :•]I=ES1FX - TME & DisT tf,•Krz 0.00
OLiCna_�e TIIIM & DISTANCE - ALLC'iIA3aC3 Rental -258.05 -258.05.
License# D_SCC.'W^_ - TZRH & DIS'7 3.30% 623.52 3i.18 '
Statel=_ov:.noe Ii:COF.RE PRODUCT CGDE TE-CR Renta: -4.99 -4.99
F,,lyms Dviren 59 RENTAL EXCISE 2AY- 4 2CT 590.11 23.60
� .[•::ICYIS Our 596; 25 days '].11 ^5
O�ZdiFars Jr.. 5190 SALES TAX -97.COG 590.:0 11.3_
P_
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ti
r
M
J•]essages
Q
H
Z' Taxable Items
LLJ i1J_lecv to Audit
Q
C-3 Ctxaiges USE 655.01
J
Z Voucher BUSINESS A,-CC -APFLICi,Id'-'
O � 1
00
oa
O ustomer Service Mune= :-800-458-3334
`�iIS .:V•0.C3 RE3L.kCES UNOICE: 4-0053L.98422
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00 ,most Due
a&c -S55.01u1
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U
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 370613 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
EAN SERVICES, LLC IN SUM OF$ CITY OF CARMEL
PO BOX 402383 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.
ATLANTA, GA 30384-2383
Payee
$497.30
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
RA 639355850 43-570.00 $497.30 1 hereby certify that the attached invoice(s),or 4/8/18 RA 639355850 LEIU conference rental car $497.30
1110 210 1110 210
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, May 1,2018
&.. ' e��
Jim Barlow
Chief
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
• r RA # 639355850 Ret
Rental Location Renter Name ROBERT LOCKE
JOHN WAYNE ARPT 08-APR-2018 02:15 PM 539 CEDAR LAKE CT
19051 AIRPORT WAY NORTH CARMEL IN 46032
SANTA ANA CA 92707 Phone (888)826 6890
CARMEL POLICE
Contract ID CITY OF
Return Location illing Reference# MARIE DOAN
JOHN WAYNE ARPT 13-APR-2018 08:00 AM
harges No Unit Price/Unit Amount
Vehicle # J9150408 [TIME & DISTANCE 1 Weeks 337.01 337.01 *
Model IMPALA ;UNLIMITED MILES/KM - TIME & DIST M/Kms 0.00 *
Class Driven PXAR /DISCOUNT - TIME & DIST 5.00& 337.01 -16.85 *
Class Charge FCAR DAMAGE WAIVER 5 Days 16.99 84.95
License# 8BBM752 CONCESSION FEE RECOVERY 11.11 PCT 411.96 45.77 *
State/Province CALIFORNIA TOURISM COMMISSION REC 3.50 PCT 320.16 11.21
M/Kms Driven 1423 VEHICLE LICENSE RECOVERY FEE 5 Days 1.37 6.85
M/Kms Out 5407 SALES TAX @7.750 % 365.93 28.36
M/Kms In 6830
Rate Info
Messages
* Taxable Items
Subject to Audit
Total Charges USJ497.30
Payments
Voucher BUSINESS ACCOUNT-APPLICANT
Customer Service Number 1-800-468-3334
THIS INVOICE REPLACES INVOICE: 60032330205
Amount Due USD 497.30
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 370613
EAN SERVICES, LLC IN SUM OF$ CITY OF CARMEL
PO BOX 402383 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.
ATLANTA, GA 30384-2383
Payee
$2,559:90
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
HG�1TF' Terms
R!M:e!c-2®181911and Task 2018 Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members. DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
445809784 43-526.00 $853.30 1 hereby certify that the attached invoice(s),or 4/24/18 445809784 $853.30
911 911 911 911
446087962 43-526.00 $853.30 bill(s)is(are)true and correct and that the 4/24/18 446087962 $853.30
911 911 materials or services itemized thereon for 911 911
911 446001089 I 43-526.00 I $853.30 4/24/18 I 446001089 I I $853.30
911 which charge is made were ordered and 911 911
received except
Wednesday, May 02,2018
Frost, Dwight
Major
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
Rental Agreement#: 446001089
Bill Ref#: 4005-3130-544
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
BILLING DETAIL
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
DISCOUNT 5.00% -45.00
BILL TO INCORRECT PRODUCT CODE RATE-CR 1 RNT -4.99 -4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE
VEHICLE LICENSE FEE REC 0.11/DAY 30 DAY 0.11 3.30
CARMEL, IN-46032 PCT 7.00 59.73
RENTAL INFORMATION SALES TAX
Date/Time Out Date/Time In Amount Due (USD) 913.03
03/16/2018 09:00 AM 04/15/2018 09:00 AM ndividu I line item char es such as rental rates for Time d i tanca, erce to a-based charg s
#e. s�es taxe and �ees or surchar�es�,and cf�argehs r vada belt e�n mul�i a rhes may�e
o de u Or,��sowp a hol cent to e s re that t e c arges equa a actua otalaAmount D a
Renter an o old fractionalcan s.
SAMUELSON,JOSHUA
RENTAL VEHICLES 7 S
Miles/Kms
Color License Model unit Out In
VIN•2._ �s .
CLAIM INFORMATION
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
Its
Its
For Billing Inquiries/Payment Terms
Tel#:+1 3178449011
INDARADMIN@EHI.COM
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.
Thank Van Tiny Chnneina Natianal far lPantal
, l
Rental Agreement#: 446087962
I Lwla ' Bill Ref#: 4005-3224-128
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
BILLING,DETAIL t-
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
DISCOUNT 5.00% -45.00
BILL TO INCORRECT PRODUCT CODE RATE-CR 1 RNT -4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE
CARMEL, IN-RE VEHICLE LICENSE FEE REC 0.11/DAY 30 DAY 0.11 3.30
RENTAL INFORMATION SALES TAX PCT 7.00 59.73
Date/Time Out Date/Time In Amount Due (USD) 913.03
03/25/2018 12:00 PM 04/24/2018 12:00 PM dividual line item c?Fes such as rental rates fo Time jod�as�°nce erce to a-based charges
e. s es taxe an ees or surchar es,and c arg s ivi e t ��n mul ID�e parties ma be
o tlei u or sown a hol cent to e�s�re that a cPharges equa� a actu 'Tot81 Amount�ue
Renter an�or to avioid fractional"can�s.
ADAMS, ERIC 3
RENTAL VEHICLES jrMP7 — S�.?
Miles/Kms
Color License Model Unit Out In
WWI ------ -----
VIN: ----- -----
VIN:
CLAIM INFORMATION
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
For Billing Inquiries/Payment`Terms :
Tel#:+1 3178449011
INDARADMIN @ EHI.COM
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.
Thank You For Choosing National Car Rental
Rental Agreement#: 445809784
Bill Ref#: 4005-2971-826
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
BH.LINGDETAIL,
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
DISCOUNT 5.00% -45.00
BILL TO INCORRECT PRODUCT CODE RATE-CR 1 RNT -4.99 -4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE
VEHICLE LICENSE FEE REC 0.11/DAY 30 DAY 0.11 3.30
CARMEL, IN-46032 PCT 7.00 59.73
RENTAL INFORMATION SALES TAX
Date/Time Out Date/Time In Amount Due (USD) 913.03
03/05/2018 03:04 PM 04/04/2018 03:04 PMndividu��l lire item cF�arpes such as rental rates for Time�nd�as�ance,�erce�ta�e•based charges
e. s es axe an ees or surchar est, and c harg s m a et e n mul i e arrtt es ma be
o de u or�own a hol cent to e s re that t e c arges equal f6e actua otal Amount�ue
Renter an�ortoavioid ractiona�cenls.
BUEHRE,BRENDAN
RENTAL VEHICLES:= ��
Miles/Kms
Color License Model Unit Out In c�
a
VIN:'
CLAIM INFORMATION -
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
For Billing Inquiries/Payment Terms
Tel#:+1 3178449011
INDARADMIN Q EHI.COM
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.
Thank Vnn Fnr Chnncina Natinnal Car Rental
Rental Agreement#: 446001089
a Bill Ref#: 4005-3130-544
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
�BILLING'DETAII:
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
DISCOUNT 5.00% -45.00
$u+L To , INCORRECT PRODUCT CODE RATE-CR 1 PINT4.99 4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE 30 DAY 0.11 3.30
CARMEL,IN-46032 VEHICLE LICENSE FEE REC 0.11/DAY
�"� SALES TAX PCT 7.00 59.73
,RENTAL-INFORMATION ;
Date/Time Out Date/Time In Amount Due (USD) 913.03
03/16/2018 09:00 AM 04/15/2018 09:00 AM ndividuil line item c?pes such as rental rates for Time rddD sTbance,Xerce It e-based charges
No, s as taxe an ees or surchar est,and c Karg s rvi a et e n mul i e arties ma�L be
Renter o de u or�owp a hol cent to e s re that t e c arges equal the actua otal AmountUue
an§or to avoid frachona�car s.
SAMUELS 0N JOSHUA
RENTAL VEHICLES 73
iA-k t`�kc��7 � � J
Miles/Kms
Color License Model Unit Out In
CLAIM INFORMATION
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
i—
Eor Billing In uiries/Payment Tecins.
Tel#:+1 3178449011
INDARADMIN @ EHI.COM
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.
i
Rental Agreement#: 446087962
Bill Ref#: 4005-3224-128
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
BILLING DETAIL .
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
������� DISCOUNT 5.00% -45.00
BILL TOS' 1 INCORRECT PRODUCT CODE RATE-CR 1 RNT -4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE
VEHICLE LICENSE FEE REC 0.11/DAY 30 DAY 0.11 3.30
CARMEL,IN-46032
SALES TAX PCT 7.00 59.73
RENTAL INFORMATION
Date/Time Out Date/Time In Amount Due (USD) 913.03
03/25/2018 12:00 PM 04/24/2018 12:00 PM �diividua I line item char es such as rental rates for Time d Di taence,percenttge-pbaarsted chalrLges
toi�ryil6'�ug ore�ow[i a ✓hole cent toga s�re that thergctsagas equalti{eeeactualI'TI A�mountybua
Renter an or o a oid ractiona cents.
ADAMS,ERIC 7j
RENTAL VEHICLES %A't; ER to S
Miles/Kms
Color License Model Unit Out In
-VIN:.' ---- --=
VIN:
CLAIM INFORMATION --~
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
For Billing Inquiries/Payment Terris
Tel#:+1 3178449011
INDARADMIN @ EHI.COM
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.
Rental Agreement#: 445809784
Bill Ref#: 4005-2971-826
Invoice Date: 04/24/2018
1748 E 116TH ST Account#: XZ08968
CARMEL, IN 46032
BILLING DETAE
Description Qty/Per Rate Amount
TIME&DISTANCE 1 MTH 899.99 899.99
DISCOUNT 5.00% -45.00
'BILL TO , INCORRECT PRODUCT CODE RATE-CR 1 PINT -4.99 -4.99
CITY OF CARMEL POLICE DEPT
ATTN:MARIE DOAN Subtotal 850.00
3 CIVIC SQUARE 30 DAY 0.11 3.30
VEHICLE LICENSE FEE REC 0.11/DAY
CARMEL, IN 46032 PCT 7.00 59.73
RENTAL INFORMATION . SALES TAX
Daterrime Out Date/rime In Amount Due (USD) 913.03
03/05/2018 03:04 PM 04/04/2018 03:04 PM dividu I line item char es such as rental rates fo Time d i ance, erce to a-based cher,es
e. s, taxe and �ees or surchar�es�,and c arge�s�ivider bet te�n m.�ilge p'rhes maIN
Renter o de u Or,�owp a hol cent to e s re that t e c arges equal ine actua otal Amountue
anoro a�io�d fractiona�cen�s.
BUEHRE,BRENDAN
RENTAL VEHICLES. ��
Miles/Kms
Color License Model Unit Out In
VIN:'
CLAIM INFORMATION
Claim#/PO#/RO# Insured
Date of Loss Type of Loss Type of Vehicle
Repair Shop
-For Billing Inquiries'I Payment Terms': ri
Tel#:+1 3178449011
INDARADMIN Q EHI.COM —
Payment Due within 30 days of invoice date
Late payments are subject to a finance charge.