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Home My WebLink About184206 04/14/2010 \f CITY OF CARMEL, INDIANA VENDOR: 00350155 Page 1 of 1 ONE CIVIC SQUARE CARMEL AUTO REFINISHING i, CARMEL, INDIANA 46032 308 GRADLE DRIVE CHECK AMOUNT: $220.90 CARMEL IN 46032 CHECK NUMBER: 184206 CHECK DATE: 4/14/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 21857 220.90 REPAIRS TO VEHICLES CARMEL AUTO REFINISHING NVOICE Federal Tax ID: 0 Estimate 308 GRADLE DRIVE. Customer No: 2030 Carmel, IN 46032 Report No: 2068 41512010 Phone (317) 815 -8379 Claim 14301147703 Fax (317) 844 -6659 Assign No: Vehicle Information Owner Carmel police dent. Car 66 Accident Location 2009 Chevrolet Impala 3 civic sq Style: 4D SED POLICE Carmel, IN 46032 Golor: Home Phone: (317) 571 -2500 Color Code: Work Phone: (317) Phone #1: Production Date: 0 Fax (317) Phone #2: License: State: IN Insured Claimant VIN 2G 1 W S57M291308534 Miles In: 0 Miles Out: 0 Condition: Home Phone: (317) Home Phone: (317) Work Phone: (317) Work Phone: (317) Estimator: Fax (317) Fax (317) Date Assigned: 3/27/2010 Date of Loss: 3/27/2010 Date of In 3/ 27/2010 Description of Work Part Number Price Labor Paint Other REAR LAMPS TAIL LAMPS Replace Left Rear Tail lamp assy 25971597 $194.67 0.3' body Sub Totals $194.67 0. THANK YOU FOR LETTING US SERVE YOU Hours Rate Total Body Labor 0.3hrs $42.00 /hr $12.60 OEM Parts $194.67 T Tax $194.67 7.0000% $13.63 Grand Total $220.90 Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Guide used is (DR1 C1306). 12/09 Indicates Estimatoes Judament T Indicates Taxed Item CCC Comp -Est A product of CCC Information Services Inc. Page 1 of 1 INDIANA RETAIL TAX EXEMPT PAGE Ci ®f .0 C� rme CERTIFICATE NO. 003120155 002 0 1 �5.� PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 21857 35- 60000972 30 .NEZCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Marc 18, 2010 repairs to vehicle VENDOR Cammel Auto Refinishing SHIP City' of Carmel Police Department. 308 Cradle Drive TO 3 Civic. Sgqare Carmel, IN 46032 CaE=kl IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION repairs to car 66 Amos 220.90 2 u ov frCE�z Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT F PROJECT ACCOUNT AMOUNT 1110 510 auto repairs and main anc pAYMENT NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND I VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY T HAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENTTO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED.�� PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Assistant Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. G lA CLERK TREASURER DOCUMENT CONTROL NO A COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. FWARNANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I 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,-- 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund cLAlM NO 14 -3011 -477 POLICY NO 1896 910 -14 LOSS DATE 02 -27 -2010 PAYMENT NO 1 18 675529 J ....Covers a Deseri tion Amount COL Ra DATE 03- 08 -2Q10 PROPERTY DAMAGE LIABILITY $220.90 200 :,Y 1 AMOUNT $220.90 "F a\ TIN ,r d ENTERED BY FOGAROLI, DAWN i AUTHORIZED BY FOGAROLI, DAWN PHONE (888) 835 -6718 REMARKS Repairs based on inspection by State Farm LETTER wlest STATE FARM MUTUAL AUTOMOBILE INSURAA� 5529 J WEST LAFAYETTE, IN JPMORGAN CHASE i MS °'•M CLM CENTRAL-AUTO 18 -930 L087 COLUMBUS, OH 3 -2010 D yyyY CLAIM NO 14 -3011 -477 INSURED WAGONER, ANDREW LOSS DATE 02 -27 -2010 TWO,Hl3NDRED T' ENT Pay to the Order of: CITY OF CARMEL 3 CIVIC SQUARE�'�' CARMEL IN 46,032 CLAIM NO 14- 3011 -477 POLICY NO 1896- 910 -14 LOSS DATE 02 -27 -2010 PAYMENT NO 1 18 675529 J Covers a Deseri tion :Amount COL Pa Cd GATE 03 -08 -2010 PROPERTY DAMAGE LIABILITY $220.90 200 1 AMOUNT 220.90 TIN AUTHORIZED BY FOGAROLL DAWN PHONE (888) 835 -6718 REMARKS Repairs based on inspection by State Farm LETTER wlest 'S FA hI MUTUAL AUTOMOB!LE i$ U�ANCE -CO PA I' ;1 1lEST,: AFF'YEL7E, IN 3PMORGAN CHASE RANK, NA 56-154 4/441; CLM CENfiEAL AUTO 1� 934 087 COLUMBUS OH r 63 4846 1 b L i DATE` drJ y y y x CLAIM N7 14- FNSUjkED WAGONER PiNDREW LOSS DATE 02= 27`,010 *EXACTLY TWO'HUNDRED TWENTY 'AND 90 /100;DOLLARS *220..9:0 'Pay to the `,Order of.. CITY OF CARMEL 3 CIVIC SQUARE CARMEL IN 46032 AUTNORIZED AUTHORIZED'$(GNATURi 11' L8L767552911' 1:044LL54431:626290233110 Of City of Carmel Cq z One Civic Square v, s h Carmel, Indiana 46032 i 317.571.2400 Price Quote Data Form Date: 3/17/2010 P.O. 21857 Vendor Item Price Quotation (Name, Address Telephone Number) Carmel Auto repairs to vehicle $220.90 Refinishing 308 Gradle Drive Carmel, IN 46032 Buyer: Carmel Auto Refinishing Reason Order Was Placed With Successful Vendor: Preferred Vendor, Order placed by: Jason Ogle Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Carmel Auto Refinishing 21857F Purchase Order No. 308 Gradle Dr Terms arme IN 46U32 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 4/5/10 payment for repairs to car 66 220.90 Total 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 Clerk- Treasurer VOUCHER NO. WARRANT NO, ALLOWED 20 IN SUM OF Carmel Auto Refinishing 308 Cradle Dr Carmel, -TN -46032 220.90 ON ACCOUNT OF APPROPRIATION FOR po gener f u n d Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT I hereby certify that the attached invoice(s), or 21857F 510 220.90 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 April 7, 20 10 S ie tr of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund