HomeMy WebLinkAbout174034 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $144.14
CARMEL, INDIANA 46032 PO BOX 633197
CINCINNATI OH 45263 -3197 CHECK NUMBER: 174034
CHECK DATE: 6/24/2009
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
.601 5023990 01830 130184 144.14 OTHER EXPENSES
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- 800 835 -2092
INVOICE 01830 130184 INVOICE: 05/20/09 BD
ORDERED: 05/19/09 INSTALLED: 05/20/09
PLEASE REMIT PAYMENT TO: W.O. 256906 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CITY OF CARMEL(WATER)
CINCINNATI, OH 45263 3197 00 CC
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032 -0000
PH1 :317 733 2853 PH2:
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074
POLICY P09 /REF
CLAIM LO S LOC
AUTH /VER: LOSS DATE /CAUSE:
2006 FORD F SERIES F150 2 DOOR SUPE ARR: INSTORE
MILEAGE•
VIN: 1FTRF12W86NB10447 LICENSE /ST: STOCK it:
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO15 1 GTY 218.85 164.14 .00 .00 .00 164.14
WINDSHIELD
1 DISCOUNT 20.00 .00 .00 .00 .00
DISCOUNT
PART TOTAL 164.14
LABOR TOTAL 0.00
SUB -TOTAL 164.14
DISCOUNT 20.00
SUB -TOTAL 144.14
SALES TAX 0.00
P A Y T H I S A M 0 U N T 144.14
NET 30
ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A
SAFELITE AUTOGLASS 01830
INDIANAPOLIS IN 49268
SAFELITE TAX ID 36 4523816
052009 062398 062398 00590
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 20090520 0000000020090520742
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
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Payee
358894
SAFELITE FULFILLMENT INC Purchase Order No.
PO BOX 633197 Terms
CINCINNATI, OH 45263 -3997 Due Date 6/16/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/16/2009 01830 -13018 $144.14
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have au dited same in accordance with IC 5-11-10-1.6
Date Officer
VOUCHER 092087 WARRANT ALLOWED
358894 IN SUM OF
SAFELITE FULFILLMENT INC
PO BOX 633197
CINCINNATI, OH 45263 -3197 ,pR NS'
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
01830 13018 01- 6500 -04 $144.14
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Voucher Total $144.14
Cost distribution ledger classification if
claim paid under vehicle highway fund