HomeMy WebLinkAbout328107 07/25/18 (9,
CITY OF CARMEL, INDIANA VENDOR: 358894
ONE CIVIC SQUARE SAFELITE FULFILLMENT INC CHECKAMOUNT: $*******321.97*
CARMEL, INDIANA 46032 PO BOX 633197 CHECK NUMBER: 328107
CINCINNATI OH 45263-3197 CHECK DATE: 07/25/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830-311810 321.97 AUTO REPAIR & MAINTEN
VOUCHER NO. WARRANT. NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 358894
IN SUM OF$ CITY OF CARMEL
SAFELITE FULFILLMENT INC
PO BOX 633197 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.
CINCINNATI, OH 45263-3197
Payee
$321.97
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire 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
01830-311810 43-510.00 $321.97 1 hereby certify that the attached invoice(s),or 7/23118 01830-311810 $321.97
1120 101 1120 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
Monday,July 23,2018
David Haboush
Fire Chief
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
120-
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
SAFELITE FULFILLMENT,INC.
1.0012-01 CUSTOMER SERVICE CENTER 1-800-835-2257
Safelife.
AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-311810 INVOICE: 07/19/18 BD
ORDERED: 07/17/18 INSTALLED: 07/19/18
PLEASE REMIT PAYMENT TO: W.O. # : 945110 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
(( PH1:317-690-4283 PH2:317-690-4283
CARMEL, CITY OF Acct #: 062398
3400 W 131 ST
WESTFIELD IN 46074
POLICY# PO#/REF : FIREDEPARTMENT
CLAIM # UT341 LOSS LOC:
AUTH/VER: JASON LOSS DATE/CAUSE: 07/19/18
2011 FORD F SERIES F150 4 DOOR CREWOR CREWTIONA ARR: MOBILE
MILEAGE: 663
VIN: 1FTFW1ET2BKD86932 LICENSE/ST: UNK IN STOCK #: UT341
QTY PART # LIST SELLING LABOR KIT _MATERIAL EXTENSION
1 DW01747 GTY 226.77 249.99 60.00 .00 .00 309.99
SOLAR-W/THIRD VISOR FRIT
1 DISPOSAL FEE 4.95 .00 7.99 .00 .00 7.99
DISPOSAL FEE
1 FUEL SURCHARGE 3.99 .00 3.99 .00 .00 3.99
FUEL SURCHARGE
PART TOTAL 249.99
LABOR TOTAL 71.98
SUB-TOTAL 321.97
SALES TAX 0.00
P A Y T H I S A M 0 U N T 321.97
TERMS:
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
STORE LIC #: SAFELITE TAX ID #: 36-4523816
071818-062398-062398 00590-062398-311810
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20180719 0000000020180719742