HomeMy WebLinkAbout188505 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $64.95
CARMEL, INDIANA 46032. PO BOX 633197
CINCINNATI OH 45263 -3197
CHECK NUMBER: 188505
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 0180 148988 64.95 AUTO REPAIR MAINTEN
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 148988 INVOICE: 07/16/10 BD
ORDERED: 07/15/10 INSTALLED: 07/16/10
PLEASE REMIT PAYMENT TO: W.O. 328066 REFERRAL 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL STREET DEPT
CINCINNATI, OH 45263 3197 3400 W 131 ST
PLEASE WRITE INVOICE NUMBER ON CHECK WESTFIELD IN 46074
PH 1.317 2001 PH2:317 5053
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074
POLICY# PO# /REF
CLAIM LOSS LOC:
AUTH /PER: JEFF LOSS DATE /CAUSE:
2006 FORD F SERIES F250 2 DOOR STAN ARR: MOBILE
MILEAGE: 30,000
VIN: 1FTNF2155GEB72403 LICENSE /ST: 68253 IN STOCK 2
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 MWSREPAIR .00 .00 64 -95 .00 .00 64.95
MOBILE WINDSHIELD 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
SAFELITE AUTOGLASS 01830
INDIANAPOLIS IN 46268
SAFELITE TAX ID 36 4523816
071910 062398 00590 062398 148988
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20100716 0000000020100719JBL
VOUCHER NO. WARRANT NO.
Safelite Fulfillment, Inc. ALLOWED 20
IN SUM OF
P. O. Box 633197
Cincinnati, OH 45263 -3197
$64.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member;
2201 01830 148988 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
Tiuesc yhuly 27, 2010
Street Commissioher
s 1
C Cu YitleSSiu i
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))
07/16/10 01830- 148988 $64.95
1 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