189377 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 361690 Page 1 of 1
0 ONE CIVIC SQUARE HUBLER EXPRESS COLLISON
CARMEL, INDIANA 46032 503 W CARMEL DR CHECK AMOUNT: $235.25
CARMEL IN 46032
CHECK NUMBER: 189377
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 26998 53193 235.25 CAR 32 REPAIRS
Date: 08/24/2010
Hubler Express Collision Carmel INVOICE
503 West Carmel Drive RO 53193
Carmel, IN 46032
317) 569 -9884, (317) 569 -9885 (fax) Est: A Brumfield
CITY OF CARMEL 09 CHEV IMPALA POLICE
CITY OF CARMEL Color: WHITE Adjustor:
1 CIVIC SQUARE Type: PC 4D SED
CARMEL, IN 46032 VIN: 2G1WS57M191308315 Phone:
Claim
Home: Prod Date: Plate: IN unk Deductible: 0
customer pay
Deducti
Work: Mileage: unk
Fax: En 6-3.9L-Fl
Loss Type: Other
t P W Pa In surance, C Custo
Sup Labor Paint
L0,Y Type Description Part# Amount Labor �Op Units Units P
1
I
1
1 Parts FRONT DOOR RT Mirror assy L
New _2594.71.96_ 151,.05 T _Body Reol _0.3 0.6
dvYdefogger'grained
FRONT DOOR Add for Clear Coat 0.1 C
Parts Other FRONT DOOR RT R &I trim panel Body R &I 0.4 i C
1 Haz FRONT DOOR Hazardous waste 3.00 Body C
removal
Pnt/Mat MISC Paint Materials 19.60 I 0.7 C
SubTotal T 235.25
Taxes 11.95
Grand Total 247.20
Due from Insurance Due from Cust
Sub -Total 0.00 Sub -Total 235.251
Tax 0.00 Tax
Total 0.00 Total 20
To Amount 247.20
INVOICE #22 08/24/2010 04:51;14 PM RO# 53193 Hubler Express Collision Carmel
Page 1
INDIANA RETAIL TAX EXEMPT PAGE
C f C me l CERTIFICATE NO. 003120155 002 0 tL�s1i ��LL PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972
3 CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
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.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
August 13 2011) vehicle repairs
VENDOR Hubler Express Collision SHIP Cit of Carmel Police- Departnatt
503 W. Carmel Drive TO 3 Civic Square
Carmel, IN 66032 Carmel IN 46032
CONFIF7MATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY 7 UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
repairs to car 32 J Smiley 235025
r
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w it A r 4
°9 so- °�'o.S*.�h`�,.���
Send Invoice To:
City of Camel P ®lie Departme>
ATTN Teresa Anderson:"
3 Civic. Square
Carmel, IN 46002
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
1110 510 auto repairs and main net P AYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
1 NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief o f P lice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. 2 6 9 9 8
A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE
i
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# EP or INVOICE NO, ACCT #fTITLE AMOUNT
D 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
__�e 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
Hubler Express Collision Purchase Order No. 26998F
503 West Carmel Drive Terms
Carmel, IN 46032 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8124/10 53193 payment for repairs to car 32 Smiley 235.25
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
Hurl Qg Ezpress Collsion IN SUM OF
503 West Carmel Drive
Carmel, IN 46032
235.25
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
D1 PT INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
26998F 53193 510 235.25 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
August 20 10
Signature
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund