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HomeMy WebLinkAbout209663 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1 ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $246.89 CARMEL, INDIANA 46032 PO BOX 633197 CINCINNATI OH 45263 -3197 CHECK NUMBER: 209663 CHECK DATE: 6/5/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 00393 442440 246.89 TRANSPORTATION EXPENS 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 INVOICE 00393 INVOICE: 05/19/12 BD ORDERED: 05/14/12 INSTALLED: 05/19/12 PLEASE REMIT PAYMENT TO: W.O. 453056 REFERRAL 000000 SAFELITE FULFILLMENT, INC INSURED: P.O. BOX 633197 CARMEL, CITY OF CINCINNATI, OH 45263 3197 3400 W 131 ST PLEASE WRITE INVOICE NUMBER ON CHECK WESTFIELD IN 46074 PH1:317 571 2255 PH2:317 CARMEL, CITY OF 3400 W 131 ST WESTFIELD IN 46074 POLICY# PO# /REF 51412TV CLAIM LOSS LOC: AUTH /VER: TIM LOSS DATE /CAUSE: 05/19/12 2004 FORD F SERIES F250 2 DOOR SUPE ARR- MOBILE MILEAGE: 1 VIN: 1FTNX21L34EC14530 LICENSE /ST: W IN STOCK #119 QTY PART LIST SELLING LABOR KIT MATERIAL EXTENSION 1 DWO1537 GBY 217.41 184.95 50.00 .00 .00 234.95 SOLAR W /THIRD VISOR FRIT AFTERMARKET 1 DISPOSAL FEE 4.95 .00 7.95 .00 .00 7.95 DISPOSAL FEE 1 FUEL SURCHARGE 3.99 .00 3.99 .00 .00 3.99 FUEL SURCHARGE PART TOTAL 184.95 LABOR TOTAL 61.94 SUBTOTAL 246.89 SALES TAX 0.00 P A Y T H I S A M O U N T 246.89 —TERMS_:__NET_10 ADDITIONAL INFO /CLAIMANT SERVICED BY: COUNTY /A SAFELITE AUTOGLASS 00393 ANDERSON IN 46016 SAFELITE TAX ID 36 051912 062398 062398 00590 062398 CARMEL, CITY OF 3400 W 131 ST WESTFIELD IN 46074 20120519 0000000020120519742 VOUCHER 121053 WARRANT ALLOWED 358894 IN SUM OF SAFELITE FULFILLMENT INC PO BOX 633197 CINCINNATI, OH 45263 -3197 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 00393 44244E 01- 6500 -04 $246.89 1 Voucher Total $246.89 Cost distribution ledger classification if claim paid under 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 358894 SAFELITE FULFILLMENT INC Purchase Order No. PO BOX 633197 Terms CINCINNATI, OH 45263 -3197 Due Date 5/30/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/30/2012 00393 -44244 $246.89 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 Date Officer