HomeMy WebLinkAbout201404 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
e CHECK AMOUNT: $78.93
PO BOX 633197
CARMEL, INDIANA 46032
CINCINNATI OH 45263 -3197 CHECK NUMBER: 201404
o
CHECK DATE: 9/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4351000 01830 171376 78.93 AUTO REPAIR MAINTEN
SAFELITE FULFILLMENT, INC CUSTOMER SERVICE CENTER 1 -800- 835 -2257
dba: Safelite. AutcGlass, Elite Auto Glass,
Auto Glass Specialists, and IF YOU HAVE ANY QUESTIONS REGARDING
Diamond Triumph Glass PAYMENT OF THIS INVOICE: 1 800
INVOICE 01830 171376 INVOICE: 09/01/11 BD
ORDERED: 08/30/11 INSTALLED: 09/01/11
PLEASE REMIT PAYMENT TO: W -O. 407038 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL COMMUNITY SERVICE
CINCINNATI, OH 45263 1 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032
PH1:317- 571-2444 5!2 'la7g571 -2444
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CARMEL COMMUNITY SERVICE
1 CIVIC SQUARE PEICLE -q-`o
CARMEL IN 46032
IS
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POLICY# PO# /REF
CLAIM LOSS LOC: w
AUTH /VER: ADAM LOSS DATE /CAUSE:
�p 6 L
2005 FORD ESCAPE 4 DOOR UTIL ARR- MOBILE
MILEAGE: 1
VIN: 1FMCU96H76KA26087 LICENSE /ST: 68555 IN STOCK
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 MWSREPAIR .00 .00 69.95 .00 .00 69.95
MOBILE WINDSHIELD REPAIR
1 SUPPLIES REPAIR 4.99 4.99 .00 .00 .00 4.99
REPAIR SUPPLIES
1 FUEL SURCHARGE 3.99 -00 3.99 .00 .00 3.99
FUEL SURCHARGE
PART TOTAL 4.99
LABOR TOTAL 73.94
SUB TOTAL 78.93
SALES TAX 0.00
P A Y T H I S A M O U N T 78.93
ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A
SAFELITE AUTOGLASS 01830
INDIANAPOLIS IN 46268
SAFELITE TAX ID 36 4523816
090111 00810 171376
CARMEL COMMUNITY SERVICE
1 CIVIC SQUARE
CARMEL IN 4.6032 0000000020110901742
VOUCHER NO. WARRANT NO.
Safelite Fulfillment, Inc. ALLOWED 20
IN SUM OF
P.O. Box 633197
Cincinnati, OH 45263 -3197
$78.93
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
r
1192 i 01830 171376 I 43- 510.00 $78.93 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
Friday, September 09, 2011
Dir or
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))
09/01/11 01830- 171376 Windshield Repair BCE Escape $78.93
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