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