185946 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
CARMEL, INDIANA 46032 PO BOX 633197 CHECK AMOUNT: $64.95
CINCINNATI OH 45263 -3197
CHECK NUMBER: 185946
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830 145412 64.95 AUTO REPAIR MAINTEN
SAFELITE FULFILLMENT INC CUSTOMER SERVICE CENTER 1- 800- 835 -2257
dba: Safelite AutoGlass, Elite Auto Glass,
Auto Glass Specialists, and IF YOU HAVE ANY QUESTIONS REGARDING
Diamond Triumph Glass PAYMENT OF THIS INVOICE: 1 800 835
INVOICE 01830-145412 INVOICE: 05/06/10 BD
ORDERED: 05/06/10 INSTALLED: 05/06/10
PLEASE REMIT PAYMENT TO: W.O. 313937 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL FIRE DEPT
CINCINNATI, OH 45263 3197 2 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032
PH1:317 PH2:317 664 0958
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# PO# /REF CAR 4551
`C$i'�Ii�i' L`OSS�L
AUTH /VER: BOB LOSS DATE /CAUSE:
1999 GMC SUBURBAN 4 DOOR UTIL ARR: INSTORE
MILEAGE:
VIN: 1GKFK16R6XJ810323 LICENSE /ST: NA IN STOCK CAR 4551
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 WSREPAIR .00 .00 64.95 .00 .00 64.95
IN STORE W/S REPAIR
PART TOTAL 0.00
LABOR TOTAL 64.95
SUB TOTAL 64.95
SALES TAX 0.00
P A Y T H I S A -M O U N T 64.95
TERMS: NET 30
ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A
CARMEL FIRE DEPT SAFELITE AUTOGLASS 01830
2 CIVIC SQUARE INDIANAPOLIS IN 46268
CARMEL IN 46032 0000 SAFELITE TAX ID 36
050610 160295 00513 160295
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032 20100506 0000000020100506742
VOUCHER NO. WARRANT NO.
Safelite Auto Glass ALLOWED 20
�33` 57 IN SUM OF
o kv7�'
$64.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 01830- 145412 43- 510.00 $64.95 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
MAY 2 d 904(1
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- 145412 C4551 $64.95
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