172527 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
CARMEL, INDIANA 46032 PO BOX 633197 CHECK AMOUNT: $184.76
CINCINNATI OH 45263 -3197 CHECK NUMBER: 172527
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830- 129213 184.76 AUTO REPAIR MAINTEN
SAFEL I TE 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- 129213 INVOICE: 04/23/09 BD
ORDERED: 04/22/09 INSTALLED: 04/23/09
PLEASE REMIT PAYMENT TO: W.O. 253320 REFERRAL 0
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL FIRE DEPT
CINCINNATI, OH 45263 3197 2 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032 0000
PH1 :317 664 0958 PH2 :317 664 0958
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# POg /REF 4503
CLAIM 1 LO S LOC
AUTH /VER: BOB LOSS DATE /CAUSE:
2008 DODGE DURANGO 4 DOOR UTIL ARR: INSTORE
MILEAGE•
VIN: 1D8HB48N18F156241 LICENSE /ST: 74956 IN STOCK 4503
QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO15 5 GTN 246.35 184.76 .00 .00 .00 184.76
WINDSHIELD
PART TOTAL 184.76
LABOR TOTAL 0.00
SUB -TOTAL 184.76
SALES TAX 0.00
P A Y T H I S A M O U N T 184.76
TERMS: NET 30
Prescribed by State Board of Accounts City`Form No. yi01 (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))
01830 129213 4503 $184.76
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. WA RRANT NO.
Safelite Auto Glass ALLOWED 20
IN SUM OF
a� 32
$184.76
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 01830- 129213 43- 510.00 $184.76 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
MU g
✓'I ®gyp 4 d [J --�r
e
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund