HomeMy WebLinkAbout196088 03/29/2011DEPARTMENT
CITY OF CARMEL, INDIANA
ONE CIVIC SQUARE
CARMEL, INDIANA 46032
VENDOR: 358894
SAFELITE AUTOGLASS
PO BOX 633197
CINCINNATI OH 45263 -3197
ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
Page 1 of 1
CHECK AMOUNT: $69.95
CHECK NUMBER: 196088
CHECK DATE: 3/29/2011
2201 4351000 69.95 AUTO REPAIR MAINTEN
SAFELITE.AUTOGLASS
4625.W. 86TH ST
SUITE 100
1NDIANAPOLIS,IN 46268
SERVICE .QUESTIONS
CALL' 31.7. 614.4214
Technician Name'
BUTCHER;
Techn ician N 2 STAR
Date Time: 03/23/11;1
tv l e:....:`..... Stock /Un i
OOR STANDARD
8:
Purchase rd e. r
Liet .Se:l.l
Price ;Pr:ice:': Labor:'
0.00 0.00:' 69:. 95
68,.8
:68 :95,
68. 8 5:.'
0.00
68,
•0 00
Customer:
CARMEL STREET DEPARTMENT
:3400 W 1315T ST'
WESTFIELD;IN46074
Year Make'
200 FORD
License
78265
M i 'I :eage,
98888
Part Subtotal:
Flat Labor Subtotal;
"'Subtotal:
Sales Tax:
Total:
Deductible
Amount to Collect:
Amount Pald:
Amt Remaining;:
Home Phone: 317- 417= 5053
Work Phone 3 733 -2001
Contact' Phone: ;317 -733 2001.:
Work ;Order 01630_372612:-
Your :vehicle .has 'been ':Vacuumed!
Your ::exterior windows have: been Cleaned!
Signature:
MTRL::
SAFELITE FULFILLMENT, INC
dba: Safelite AutoGlass, Elite Auto Glass,
Auto Glass Specialists, and
Diamond Triumph Glass
PLEASE REMIT PAYMENT TO:
SAFELITE FULFILLMENT, INC
P.O. BOX 633197
CINCINNATI, OH 45263
PLEASE WRITE INVOICE NUMBER ON CHECK
POLICY#
CLAIM
AUTH /VER: JEFF
INVOICE 01830-161457
2008 FORD F SERIES F250 2 DOOR STAN
VIN: 1FTN21529EA02259 LICENSE /ST: 79265
QTY PART LIST SELLING
1 MWSREPAIR .00 .00
MOBILE WINDSHIELD REPAIR
TERMS: NET 30
ADDITIONAL INFO /CLAIMANT
032511 062398
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074
CUSTOMER SERVICE CENTER 1- 800 835 -2257
IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1 2092
INVOICE: 03/23/11 BD
ORDERED: 03/22/11 INSTALLED: 03/23/11
W.O. 372612 REFERRAL 000000
INSURED:
CARMEL STREET DEPARTMENT
3400 W 131 ST
WESTFIELD IN 46074
PH1:317 5053 PH2:317 733
PO# /REF
LOSS LOC:
LOSS DATE /CAUSE:
IN
LABOR KIT MATERIAL EXTENSION
64.95 .00 .00 64.95
PART TOTAL
LABOR TOTAL
SUB TOTAL
SALES TAX
ARR: MOBILE
MILEAGE: 99,999
STOCK 8—
0.00
64.95
64.95
0.00
P A Y T H I S A M O U N T 64.95
SERVICED BY: COUNTY /A
SAFELITE AUTOGLASS 01830
INDIANAPOLIS IN 46268
SAFELITE TAX ID 36
00590
20110323 0000000020110325JBL
VOUCHER NO. WARRANT NO_
Safelite Fulfillment, Inc.
4625 W. 86th Street Suite 100
Indianapolis, IN 46268
$69.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
INVOICE NO.
ACCT #/TITLE
43- 510.00
PO# Dept.
2201
Cost distribution ledger classification if
claim paid motor vehicle highway fund
AMOUNT
$69.95
ALLOWED 20
IN SUM OF
Board Members
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
Street Commissioner
St c t O Cr"'.:"..c. C7. •2.
Title
on day, 28, 2011
f/ljc.�l�f
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.
Invoice
Date
03/23/11
Invoice
Number
Payee
20
Purchase Order No.
Terms
Date Due
Description
(or note attached invoice(s) or bill(s))
Amount
$69.95
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
Clerk- Treasurer