197230 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 361690 Page 1 of 1
ONE CIVIC SQUARE HUBLER EXPRESS COLLISON CHECK AMOUNT: $235.75
CARMEL, INDIANA 46032 503 W CARMEL DR
CARMEL IN 46032 CHECK NUMBER: 197230
CHECK DATE: 5/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 27733 54204 235.75 REPAIRS TO CAR 32
Date: 04/28/2011
Hubler Express Collision Carmel INVOICE
503 West Carmel Drive RO 54204
Carmel, IN 46032
317 569 -9 317 569 -9885 fax Est: A _M
CITY OF CARMEL 109 CHEV IMPALA POLICE CITY OF CARMEL POLICE
CITY OF CARMEL Color: WHITE DEPARTMENT
1 CIVIC SQUARE Type: PC 4D SED Adjustor:
CARMEL, IN 46032 VIN: 2G1WS57M191308315 Phone:
Home: Prod Date: 0509 Plate: IN 14236 Claim VEHICLE #32
Work: Mileage: 34957 Deductible: 0
F ax: Eng 6-3.9L-Fl Loss Type Other
P Who Pays? Ins C C
Sup Labor Paint I
Qty Type Descri tion Part Amount I�Labo�r O P
Type -I- I— P Units Units i�_.—.
FRONT DOOR RT Mirror assy w/o
1 Parts New defogger grained 25947194 147.35 Body Repl 0 -3 0.6 1
FRONT DOOR Add for Clear Coat 0.1 1
Parts Other FRONT DOOR RT R &I trim panel Body R &I 0.4 1
1 Haz FRONT DOOR Hazardous waste 3 -00 Body I
removal
Pnt/Mat MISC Paint Materials 21.00 0.7 I
SubTotal 235.75
Taxes 0.00
Grand Total 235.75
D ue _from Insurance_ D ue from Custo
Sub -Total 235.75 Sub -Total .00
Tax 0.00 Tax 0.00
Total 235.75 Total 0.00
Total Amo unt 23 5.75
INVOICE #22 04/2812011 12:47:42 PM RO# 54204 Hubler Express Collision Carmel
Page 1
j� INDIANA RETAIL TAX EXEMPT PAGE
C ity o II I CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
�tiJ+ 1l
FEDERAL EXCISE TAX EXEMPT ZU33
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
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_
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
M1WI
HublGr Ettp fuss Co lliSlon Camol Police Department
VENDOR SHIP 3 Civic Squm
Mat Cumel Drava TO Carmel, IN 46M
Cumol,, IN 4 81M 579=
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43-690.0
i Each r epairs vehide $233.75 $235.75
Sub TotW: $235.75 g
I
r ti t
V
i�
jl
I 8
rop2frs to car 32 SmIloy
Send Invoice To: j
Cumol Police Dop &trno t
Attu: Toroom Andomon
3 CIVIC equam
cumol, IN PLEASE INVOICE IN DUPLICATE
DEPARTMENT N ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmol Police Dept. C Cf' PAYMENT -75F
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THA fT HERE IS AN UNOBUGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATIO JSUFFICIENTTO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY III
SHIPPING LABELS. �Ief Q P Po lice
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE f
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO-
CLERK-TREASURER
DOCUMENT CONTROL NO-27733 A.P.V. COPY SIGN AND RETURN TO CLERK OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
i
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT, 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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
HUbler Express Collision
IN SUM OF
503 West Carmel Drive
Carmel„ IN 46032
$235.
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members
27733 54204 43- 510.00 $235.75 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
Thursday, �ay 05, 2011
4.
Chief of Police
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))
04/28/11 54204 payment for vehicle repairs to car 32 I Smiley $235.75
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