HomeMy WebLinkAbout199181 07/06/2011 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
i' ONE CIVIC SQUARE SAFELITE AUTOGLASS
i CHECK AMOUNT: $242.90
CARMEL, INDIANA 46032 PO BOX 633197
CINCINNATI OH 45263 -3197 CHECK NUMBER: 199181
CHECK DATE: 7/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01830166862 242.90 TRANS EXPENSES -CUST A
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: 1 800 835
INVOICE 01830-166862 INVOICE: 06/23/11 BD
ORDERED: 06/23/11 INSTALLED: 06/23/11
PLEASE REMIT PAYMENT TO: W.O. 391545 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL, CITY OF
CINCINNATI, OH 45263 3197 3400 W 131 ST
PLEASE WRITE INVOICE NUMBER ON CHECK WESTFIELD IN 46074
PH1:317 733 PH2:
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074
POLICY# PO# /REF 52
CLAIM LOSS LOC:
AUTH /VER: JIM LOSS DATE /CAUSE:
2002 CHEVROLET IMPALA 4 DOOR SEDA ARR: INSTORE
MILEAGE: 68,337
VIN: 2G1WF55K929287582 LICENSE /ST: 82242 IN STOCK 52
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO1377 GBY 215.93 184.95 50.00 .00 .00 234.95
SOLAR MIRROR BUTTON
1 DISPOSAL FEE .00 .00 7.95 .00 .00 7.95
DISPOSAL FEE
PART TOTAL 184.95
LABOR TOTAL 57.95
SUBTOTAL 242.90
SALES TAX 0.00
P A Y T H I S A M O U N T 242.90
TERMS: NET 30
ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A
SAFELITE AUTOGLASS 01830
INDIANAPOLIS IN 46268
SAFELITE TAX ID 36
062311 062398 00590 062398
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20110623 0000000020110623742
VOUCHER 111668 WARRANT ALLOWED
358894 IN SUM OF
SAFELITE FULFILLMENT INC
PO BOX 633197
CINCINNATI, OH 45263 -3197
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
01830166862 01- 6500 -07 $242.90
Voucher Total $242.90
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
358894
,SAFELITE FULFILLMENT INC Purchase Order No.
PO BOX 633197 Terms
CINCINNATI, OH 45263 -3197 Due Date 6/29/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bili(s)) Amount
6/29/2011 0183016686: $242.90
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
c 130/11 lam --ty—..���
Date Officer
It