The URL can be used to link to this page

Home My WebLink About203158 10/25/2011 CITY OF CARMEL INDIANA VENDOR: 358894 Page 1 of 1 h ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $310.89 CARMEL, INDIANA 46032 PO BOX 633197 t CINCINNATI OH 45263 -3197 CHECK NUMBER: 203158 CHECK DATE: 10/25/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 4351000 415013 310.89 AUTO REPAIR MAINTEN 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 INVOICE 01830 173530 INVOICE: 10/14/11 BD ORDERED: 10/12/11 INSTALLED: 10/14/11 PLEASE REMIT PAYMENT TO: W.O. 415013 REFERRAL 0 SAFELITE FULFILLMENT, INC INSURED: P.O. BOX 633197 CARMEL COMMUNITY SERVICE CINCINNATI, OH 45263 3197 1 CIVIC SQUARE PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032 0000 PH1:317 571 PH2: CARMEL COMMUNITY SERVICE 1 CIVIC SQUARE CARMEL IN 46032 POLICY# PO# /REF CLAIM LOSS LOC: AUTH /VE.i—LISA- LOSS DATE /CAUSE: 2008 FORD ESCAPE HYBRID 4 DOOR UTIL ARR: MOBILE MILEAGE: 37,865 VIN: 1FMCU59H18KB45504 LICENSE /ST: 59C79 IN STOCK 6 QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION 1 DWO1684 GTY 286.29 248.95 50.00 .00 .00 298.95 SOLAR W /THIRD VISOR FRIT ACOUSTIC INTERLAYER 1 FUEL SURCHARGE 3.99 .00 3.99 .00 .00 3 -99 FUEL SURCHARGE 1 DISPOSAL FEE_.._,. .00 .00 7.95 .00 00 7.95 DIS, SALT FLEE 0 do 0 Z ZOII y PART TOTAL 248.95 LABOR TOTAL 61.94 v9 SUB 310.89 S 8 Z SALES TAX 0.00 P A Y T H I S A M O U N T 310.89 TERMS: NET 3 0 ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A SAFELITE AUTOGLASS 01830 INDIANAPOLIS IN 46268 SAFELITE TAX ID 36 101411 00810 309353 CARMEL COMMUNITY SERVICE 1 CIVIC SQUARE CARMEL IN 46032 0000000020111014742 VOUCHER NO. WARRANT NO. ALLOWED 20 Safelite Fulfillment, Inc. IN SUM OF P.O. Box 633197 Cincinnati, OH 45263 -3197 $310.89 ON ACCOUNT OF APPROPRIATION FOR Carmel DOCS PO# Dept. INVOICE NO. ACCT# /TITLE AMOUNT Board Members 1192 I 415013 I 43- 510.00 I $310.89 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 onday to er 4 ©11 Director 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)) 10/14/11 415013 Replace windshield vehicle #6 $310.89 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