167449 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $181.95
�o CARMEL, INDIANA 46032 4625 W 86TH ST
roN c� SUITE 100 CHECK NUMBER: 167449
INDIANAPOLIS IN 46268
CHECK DATE: 12/23/2008
DEPAR ACCOUNT PO NUMB IN N AMOUNT DESCRIPTION
112.0 4351000 01830 236335 181.95 AUTO REPAIR MAINTEN
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1 �a DIAMOND
Sa�elet�' autoGrass INIUMPH 6lA$S
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T 1 4 1
SAFELITE AUTO GLASS Date &Time: 12/16/08 9:32AM
4625 W. 86TH ST
SUITE 100
,ul_NDIANAP,OLIS IN 46
�3
RVICE QUESTIONS
CALL 317 614 4205
i
Customer 'Home Phone :31 7 416 4295 r,i
CARMEL FIRE DEPT Work Phone 3
2 CIVIC SQ 'i :Contact .Phone T
CARMEL IN 46032 Work Order# 01830 236335;
Year Make Model
2007 CHEVROLET TlaHOE
License. Style x= Stock /Unit
63225 4.DOOR 45..01
Mrleag`e VIN Purchase Order#
123;456 1GNFK13OX7J255966
Qty Part Lis_t Sellingg> Labors Ki't iMTRL
1 ,DW01658 GTVNMF 219: 50 _:131 95i; 50 _00 0 00 0 00 i
Techrilclan Name i Tech ID
JONES,ROBERT 1830 584 J
TecFin i c t an.No t o
Part Subtotal.` 13 1 95
Labor.Subtotal 50 00
Subtotal 181 9 5
Sales Tax 0 00,
Dedtictlble t 0 0 0
Amourit to Collect 0 00
Estimate 5181 95 I authonie Welite Auto'Glass m
Dlaond;Trlumph_Glass
to provide the`abc,ve referenced goods and services and t oit Iristall glass
and related parts that are manufactured by Satelltib Diamond or another
attermarket manufacturer Subject to'„'completlon of the work I assign to
Safelte /Diamond a' n yl c 1 1 ml i that I have;under my Insurance policy to
recov'.er and authorize my Insurance c'ompany• pay Satellte /Diamond theJ
balance due f said amount Is not paid In Lull by my Insurance company;
I agree to
ll pay any uripald balahce If paying ch
by eck ;and your check is
I, unpaid for (nsuttic(ent;or uncollected funds we may electronically debit`
your account for the Urinclple check amount aid a ser,vlce tee as allowable
by law You have the right to select tli;e repalraaclllty „of your choice
I have read and untlerstand the Adhe'slve Cure.; Time "C'autlon on the attached
form In most'caaes the apuroxlmate?length of time to,' complete the tasks
detailed on ttils� der Is 45 minutes to 1 hour k
ti
h
i
Safe fo drive vehicle after 2 hours f
How did we do? Tell us aboutfYour experience at www AutoGlassSurvey com
V NO. WARRANT NO.
ALLOWED 20
Safelite Auto Glass
IN SUM OF
4625 W.86th Street, Ste. 100
Indianapolis, IN 46268
$181.95
i
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 01830_236335 43- 510.00 $181.95 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
DEC 2 2 2008
a
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 236335 Windshield Car 4501 $181.95
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