166872 12/10/2008 f CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
CARMEL, INDIANA 46032 4625 w86TH ST CHECK AMOUNT: $224.60
SUITE 100 CHECK NUMBER: 166872
INDIANAPOLIS IN 46268
CHECK DATE: 12/10/2008
DEPARTMENT ACCO PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
220.1 4351000 01830 234662 224.60 AUTO REPAIR MAINTEN
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Customer 6iece�pt r
d• DIAMOND
Sadebt� AutoG7ass ;1HIUMN /1 {OCAS$
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SAFELITE AUTOCaLASS ,Date Time ;12/02/08 1 26FM
4625 W 86TH STREET
°TSUITE 100
:INDIANAPOLIS,IN:46268
*,SERVICE,�G?UEST,IONS
Customer Home Phone '317 733 2001
CARMEL, CITY OF Work Phone 31 7 41 7 5053
3400, W 13,1 $T ST .Contact;Phone 317 419 5053';
WES ?FIELDIN 4607:4 Work Order# 01830 234662
Year Mak C04�;�32�34�62�
TO
Lic'ense; ,Style,. "S•,tock /Unit#
270i13 2 ;DOOR *CONVENT I ON
Mileage VI,N Purchase Order#
10446 1G
DP 8C iC65F51 1830
ot Part L1st Sellingg' Labor K;it MTRL
.i DW01S19,CTNNMF 247 90 1133 8T 50 -00 0 00 0 00
1 WFS D1265 FLX 54 31 40 73� 0.00 0 00 0 00
Ni
Technlclan Name Tech
SUMMERS,SHAUN,C 1830 048
Techniclan;Note. r
Part Subtotal;, 174:60
Labor Subtotal 5.0� 00
Subtotal 224:60
:Sales Tax 0.00
Deductlble
Amount to Collect 0 00
Amount Pald 0 0 0
Amt Remalning 50 00
Signature
Safe to drive I e after 1 hour
How did we do? Tell us about your expeflwfc.�� at wwwAut�lGlassSurvey coma
VOUCHER NO. WARRANT NO.
ALLOWED 20
Safelite Autoglass
IN SUM OF
4625 W. 86th Street. Suite 100
Indianapolis, IN 46268
$22
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 01830- 234662 43- 510.00 $224.60 1 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, December 04, 2008
C
Street Commis i r
er
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 N umber (or note attached invoice(s) or bill(s))
12/02/08 01830 234662 $224.60
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