HomeMy WebLinkAbout189498 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 355894 Page 9 of I
0 ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $64.95
CARMEL, INDIANA 46032 PO BOX 633197
o CINCINNATI OH 45263 -3197 CHECK NUMBER: 189498
CHECK DATE: 8131/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830- 150927 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
INVOICE 01830-150927 INVOICE: 08/19/10 BD
ORDERED: 08/13/10 INSTALLED: 08/19/10
PLEASE REMIT PAYMENT TO: W.O. 334056 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
PH1:317 690 PH2:
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# PO# /REF 4591
CLAIM LOSS LOC:
AUTH /VER: JASON LOSS DATE /CAUSE:
1999 GMC YUKON 4 DOOR UTIL ARR: INSTORE
MILEAGE:
VIN: 1GKEK13R4XJ784787 LICENSE /ST: NA IN STOCK 4.591
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 WSREPAIR .00 .00 64.95 .00 .00 64.95
IN W/S REPAIR
PART TOTAL 0.00
LA30R TOTAL 64.95
SUB TOTAL 64.95
SALES TAX 0.00
P A Y T H I S A M 0 U N T 64.95
TERMS: NET 39
VOUCHER NO, WARRANT N
Safelite Auto Glass ALLOWED 20
IN SUM OF
4625 W.86th Street, Ste. 100
Indianapolis, IN 46268
$64.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #FfITLE AMOUNT
Board Members
1120 01830 150927 43- 510.00 $64.95 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
AUG 3 0 2010
fJ 'oo V V
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- 150927 $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