HomeMy WebLinkAbout192592 12/08/2010 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
0 ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $256.90
CARMEL, INDIANA 46032 PO BOX 633197
CINCINNATI OH 45263 -3197 CHECK NUMBER: 192592
CHECK DATE: 12/8/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 01830 351606 256.90 AUTO REPAIR MAINTEN
l 4,'
S,oe' ®AutoGlass
.SAF ELI TE'AUTOGLASS Date Time: 11/30/10 09:25AM
4625 W..86TH ST
SUITE'100
INDIANAPOLIS, IN -46268
*.;SERVICE` QUESTIONS
*CALL 31, 7- 614 4214
Customer Home Phone: ;'317 733.2001;
CITY OF CARMEL STREET DEPT :;;Work Phone:. !.31.7-4,1;7 5053;.
3400 W1 31:ST ST.' Contact Phone' ?317- .733 -2001
WESTF.IELD 46074 Work Order# 01830_351606
Year Make Model
20,05 GMC TOPKICK'
License Sf,yle n Stock %Un'i t#
2 DOOR NVENT I ON.
M F I "gage V I Pu:rchase Order#
i 1GDT864C45F:5 12971
Liet Sel Hris Flat
0 t y ';Par t Prj ce Pr i ce Labor K i t 'MTRL
1 DW01519GBNNMF. .222..85 185,195 SO: 00 0`.00.,
1, IWFS D'1'265 SRM 29.26. is 20.95 0''. 00 0.00 0.00 t
Technlclan Name Tech.ID
BOYER,ROB; 1830 -509
Technician;Note;
Part Subtotal; 206 90
Flan Labor Subtotal: SO 00.
Subtotal 2 5 6: 8 0
Sales Tax. 0 00
Deductible 0:00
Amount to C
ollect 0:00
,Estlmate $256 90 L�authorize Safelite AutoG. lass to provide Ahe
above referenced goods and servI' and to`Install or repalr, glass and
related are manufactured by Safellte.or another aftermarket
manufacturer'.;,Subje6t to'completion.of the work, Lasslgn to Safellte, any
clalm that I have under my Insurance policy to'recover and authorize my r
Insurance company. to pay Safellte tho balance due.If sald'`amount Is 'not
pald•In,full by.my Insurance company,'I;agree'to pay any unpal, bal
ance.
If paying by check, :and your check Is unpaid for Insufficient or!.
uncollected funds; vve may: electronically debit your account for the
princlple,check amount and'a ervlce ;fee as .allowableby lav✓.' You
have
the:rlght to select the` repair facility of your cholce. I; rea and
unde'r'stand the Adhesive,Cure Time Caution 'on the'attached!fo
de rm.. In, most,
cases,.the approximate longth of tlmejto complete the tasks tailed on
this.work order is 45 minutes to 1 hour
Signature
Safe'to.drlve vehlcle after. 2hours
VOUCHER NO. WARRANT NO_
ALLOWED 20
Safelite Fulfillment, Inc.
IN SUM OF
P. O. Box 633197
Cincinnati, OH 45263 -3197
$256.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# i Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
2201 43- 510.00 $256.90 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
r,Thursday,!becem6er 02, 2010
L40
Street Commissi r
oau d Is51oner
1 itle
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))
11/30110 $256.90
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