HomeMy WebLinkAbout180080 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 363101 Page 1 of 1
ONE CIVIC SQUARE GLASS AMERICA
CARMEL, INDIANA 46032 6155 E. 86TH ST., STE E CHECK AMOUNT: $186.73
INDIANAPOLIS IN 46250 CHECK NUMBER: 180080
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
1192 4351000 0015 -45845 186.73 AUTO REPAIR MAINTEN
FROM :GLRSS AMERICA FAX NO. :219 736 7424 Dec. 04 2009 04:33PN P1
6155 ;AST 86TH STREET, SUITE E
I.NDI'ANAPOLIS IN 46250
(317)570 -8009 Fax:(3'17)570 -798
Tax# 30- 0270064
invoice: 0015 -45845
Date: 12/03/2009
Soheduled.11 /30/200
Sold To: -�!'1. �t! �N'
C ITY OF CARM1:.1,
DEPT OF COUNTY SERVICES
ONE CIVIC
SQUARE
CARML,L IN 46032
hi,:(317)571 -2418 rax:(317)571 -2499
Csr:KERI Tech:0I 5MC PO rcrnisNET 30
Rep :JLANGE Ta.X ID:0031201550
Vchicle2006 FOkD'ESCAPE; 4 DOOR UTIT,TTY VTN: I FMCIJ96H96KA260
Part scrip
List 1'ri Material Lam It.c Total
QIX 1.00 DW 1579GBY Windshield Green Tint /Blue Shade 253,45 126.73 60.00 186.73
(w /Molding attached)(3 /4 Moulding)(Solar)(W /Third
Visor Frit) DOTN:904
2,00 HAI-1000004 Adhesive(Nags) (Urethane,Dam,Primer) 0.00 0,00 0.00
Notes: *E)O NOT COLLECT THEY HAVE•. AN ACCT ACCORDING TO VINI/ VEHICLE IS 20006
Job Location Mobilc
I I6TH KEYSTONE
CALL ADAM TO GET EXACT JOB LUCATION 405 -7285
Was the vehicle's condition sufficient For proper application of retention system? Yes _No (if No, complete and
attach Vehicle Diagnostic Form)
DOT# Place 3 lot stickers on store "file copy 1) Glass Aktivator 2)Pinchweld Primer 3)1 Jrethane
VIN#
SAF1 DRIVE AWAY TIME IS: Customer Initials:
For windshields only, the sealant manufacturer recommends you wail 1 hour after ins(allation to dri%c you r vehicle.
Remit To GLASS AMERICA
1440 Momentum Plaeo
Chicago, IL. 60689 -5314
Sil,Rtattue
Material Labor Tax Total Deductible Pa nx m Balance
126.73 60.00 0.00 186.73 0.00 0.00 186.73
vers:8.0.50 Pagc: 1 of 1
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))
12/03/09 0015 -45845 Windshield Replacement Unit 92 $186.73
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Glass America
IN SUM OF
6155 East 86th Street, Suite E
Indianapolis, IN 46250
$186.73
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1192 0015 -45845 43- 510.00 $186.73 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
Monday, December 07, 2009
it ctor, DO
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund