187333 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 361690 Page 1 of 1
ONE CIVIC SQUARE HUBLER EXPRESS COLLISON
503 W CARMEL DR CHECK AMOUNT: $981.15
CARMEL, INDIANA 46032
CARMEL IN 46032 CHECK NUMBER: 187333
CHECK DATE: 717/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 52990 981.15 AUTO REPAIR MAINTEN
S
JUL -01 -2010 07:55 From:EXPRESS COLLISION 31756998$5 To:5712512 Pa9e:2
R
b
Date: 0710112010
Hubler Express Collision Carmel INVOICE
503 West Carmel Drive RO 52990
Carmel, IN 46432
(317) 569 -9884, 317) 569 -9885 (fax) Est: KEITH H EINZMAN
i CITY OF CARMEL 09 CHEV IMPALA POLICE
CITY OF CARMEL Color: WHITE
4 1 CIVIC SQUARE Type: PC 4D SED Adjustor:
CARMEL, IN 46032 VIN; 2G1 WS57MB91306965 Phone:
Home: 317- 571 -2559 xTeresa Prod Date: 0509 Plate: IN 14373 Claim self Deductible: 0
Work: 317 733 -4600 xjason Mileage: 6528 Loss Type: Other
Fa x: Engine 6-3.9L-Fl
p r Pa s t I In s
Sup ho L suran ce
ab or Paint C Customer)
Qty Typo Description Part Amount Labor Op Units I Units P
Parts New REAR BUMPER O/H bumper assy Body Ovrh 2.3 C
1 Parts Now REAR BUMPER Bumper cover LT, 19120961 535.55 Body Repl 3.0 C
LTZ, SS, POLICE
REAR BUMPER Add for Clear Coat 1.2 C
1 Supplies REAR BUMPER Flex Additive 3.00 Body C
Sublet REAR BUMPER Hazardous waste 3.00 Body subl C
removal
REAR BUMPER Color Tint Refn 0.5 C
PntfMat MISC Paint Materials 131.60 4.7 C
SuhTotal 381.15
Taxes 0.00
Grand 'I'otal 991.15
Due from Insurance D ue from Customer
Sub -Total 0,00 Sub -Total 981.15
Tax 0.00 Tax 0.00
Total 0.00 Total 981.15
Total Amoun 981.15
INVOICE #22 07101!2010 09:02:53 AM RO# 62990 Hubler Express Collision Carmel
Pagel
it INDIANA RETAIL TAX EXEMPT PAGE
11 CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
y f Cl
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972
3M CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
May 21, 2010 repairs to vehicle
r
VENDOR SHIP
Hubler Express Collision To City o€ Cam>aelPPolice Department
503 'f. Carmel Drive 3 Civic Square
Carol, IN 46032 Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
repairs to vehicle 143 Semester 981.15
41 d�
I
t�
C 0
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 510 auto repairs and maint nanc TAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS A TI N
SHIP REPAID. FFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Agrf Chi ef of loo ce
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. 2 6 91 `j A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
�j
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
G-
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.
T Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 261 (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
Hubler Express Collision Purchase Order No. 26914F
503 West Carmel Drive Terms
;1
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
711110 52990 paymnent for repairs to car 143 Semester 98.1.15
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. 1h,JARRANT NO.
ALLOWED 20
Hub lter Express Collision IN SUM OF
503 West Carmel. Drive
Carmel, IN 46032
981.15
ON ACCOUNT OF APPROPRIATION FOR
police genera fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
26914F 52990 510 981.15 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
July 1 20 10
1
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund