HomeMy WebLinkAbout182529 02/17/2010 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $201.95
CARMEL, INDIANA 46032 PO BOX 633197
CINCINNATI OH 45263 -3197 CHECK NUMBER: 182529
CHECK DATE: 2/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830 140799 201.95 AUTO REPAIR MAINTEN
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,4625 W 86TH ST
SUITE 100
;INDIANAPOLIS,IN.46268 6 r
3ERVICE:0UEST,.I0 NS
3,17,614 4214
Customer Home Phone 317 416 4295
CARMEL FIRE DEPT Work Phone, 317 571 2600
2 CIVIC SQ Co fit act
CARMEL,IN 46032 5 Work Order# ;p01830 294985
Year Make, 6, 1, Motle 1= tl
2006 CHEVROLET IMPALA
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3Ltcense Style Stock/Uni`t
70614 4 DOOR ,SEDAN P '4504
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Mi I'eage' VI�N,F r `Purchase Order#
:182 2G'1WT58K8683.7r h
Oty Part Liet Selling' Labor K'it MTRL
I 1 DW0164 GTY �'7 220 22 151 95 50 00 0 00' 0 00,,'
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Tectiniclan Name .Tech ID'.
FISHER,LER10 Y 1830 192
Tech, n i o i an:y Note dot 563
Part Subtotal: 151 .95
Labor Subtotal: 50.00
Subtotal 201 85
Sales Tax 000',
Deductible 0 00
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Amount to Collect 0 00
Amount Pald
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How :`did we do? Tell us about your experience at www AutoGlassSurvey com
SAFELITE FULFILLMENT, INC CUSTOMER SERVICE CENTER 1- 800- 835 -2257
dba: Safelite Auto Glass, Elite Auto Glass,
Auto Glass Specialists, and IF YOU HAVE ANY QUESTIONS REGARDING
Diamond Triumph Glass PAYMENT OF THIS INVOICE: 1 835
INVOICE 01830 140799 INVOICE: 02/01/10 BD
ORDERED: 01/29/10 INSTALLED: 02/01/10
PLEASE REMIT PAYMENT TO: W.O. 294985 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL FIRE DEPT
CINCINNATI, OH 45263 2 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032 0000
PH1:317 PH2:317 571 2600
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# PO# /REF
CLAIM LOSS LOC:
AUTri /VER JEFF LOSS -DATE /CAUSE_
2006 CHEVROLET IMPALA 4 DOOR SEDA ARR: MOBILE
MILEAGE- 192
VIN: 2G1WT58K869379051 LICENSE /ST: 70614 IN STOCK 4504
QTY PART LIST SELLING LABOR KIT MA'T'ERIAL EXTENSION
1 DWO1641 GTY 220.22 151.95 50.00 .00 .00 201.95
SOLAR"ANTENNA /THIRD VISOR FRIT W /REMOTE START
PART TOTAL 151.95
LABOR TOTAL 50.00
SUB TOTAL 201.95
SALES TAX 0.00
P A Y T H I S A M O U N T 201.95
TERMS.:- NET 30
ADDI'T'IONAL INFO /CLAIMANT SERVICED BY: COUNTY /A
JEFF STEELE SAFELITE AUTOGLASS 01830
2 CIVIC SQ INDIANAPOLIS IN 46268
CARMEL IN 46032 SAFELITE TAX ID 36
020110 160295 00513 160295 140799
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032 20100201 0000000020100201742
VOUCHER NO. WARRANT NO.
Safelite Auto Glass ALLOWED 20
IN SUM OF
4625 W.86th Street, Ste. 100
Indianapolis, IN 46268
$201.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
1 120 01830- 140799 43- 510.00 $201.95 1 hereby certify that the attached invoice(s), or
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
EER1 5 2010
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01830- 140799 4504 $201.95
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer