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217185 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 361690 Page 1 of 1 ONE CIVIC SQUARE HUBLER EXPRESS COLLISON CARMEL, INDIANA 46032 503 W CARMEL DR CHECK AMOUNT: $1,082.05 CARMEL IN 46032 CHECK NUMBER: 217185 CHECK DATE: 2/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 61 . 25 AUTO REPAIR & MAINTEN 1110 R4351000 25545 11662 1, 020 . 80 REPARIS TO CAR 77 HUBLER EXPRESS COLLISION — Workfile ID: 55cc45c7 CARMEL INDIANA'S FIRST CHOICE IN COLLISION REPAIR! 503 W. CARMEL DR., CARMEL, IN 46032 Phone: (317) 569-9884 FAX: (317) 569-9885 Final Bill RO Number: 11033 Customer: Insurance: Adjuster: Al-Rep Team Estimator: Eric Tobolski CITY OF CARMEL STATE FARM INSURANCE Phone: (888)888-8888 Create Date: 10/10/2012 Evening 3400 W 131ST ST Washington Point, 147 Claim: 14-175W-17602 CARMEL,IN 46074-8267 Indianapolis, IN 46229 Loss Date: 8/16/2012 (317)571-2500 Deductible: n n Year: 2009 Style: 4D SED VIN: 2G1WS57M49130566 v Mileage In: 67990 Make: CHEV Color: DK BLUE Mileage Out: Model: IMPALA POLICE License: 14213 Job Number: Vehicle Out: 10/17/2012 Line Ver Operation Description Qty Extended Type Labor Type Paint Price$ 1 Sol FINAL BILL POA ON FILE PAY SHOP DIRECT 2 E01 REAR DOOR 3 E01 Repair RT Outer panel 1.0 Body 2.0 4 E01 Add for Clear Coat 0.8 5 E01 Remove/Install RT Body side mldg 0.2 Body 6 E01 Repair RT Body side mldg 0.5 Body 0.4 7 E01 Overlap Minor Panel (0.2) 8 E01 Add for Clear Coat 0.1 9 E01 Remove/Install RT Belt w'strip 0.3 Body 10 E01 Remove/Install RT Handle,outside w/chrome 0.3 Body 11 E01 Remove/Install RT R&I trim panel 0.4 Body 12 E01 QUARTER PANEL 13 E01 Repair RT Lower panel 2.0 Body 0.8 14 E01 Overlap Minor Panel (0.2) 15 E01 Add for Clear Coat 0.1 16 E01 Repair RT Quarter panel 10.0 Body 2.2 17 E01 Overlap Major Adj.Panel (0.4) 18 E01 Add for Clear Coat 0.4 19 E01 Remove/Replace RT Emblem flying impala 1 39.49T OEM 0.2 Body 20 E01 Remove/Install RT Qtr glass GM 1.5 Body 21 E01 Repair RT Outer wheelhouse 2.0 Body 0.4 22 E01 Add for Clear Coat 0.1 23 E01 Remove/Install Pressure vent 0.2 Body 24 E01 REAR LAMPS T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paindess Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recor=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 1/25/2013 2:29:10 PM Page 1 Final Bill RO Number: 11033 Vehicle: 2009 CHEV IMPALA POLICE 4D SED 6-3.9L-FI DK BLUE 25 E01 Remove/Install RT Tail lamp assy 0.4 Body 26 E01 REAR BUMPER 27 E01 0/H rear bumper 1.9 Body 28 E01 Remove/Replace Bumper cover w/dual exh 1 526.63T OEM 0.0 Body 3.0 29 E01 Add for Clear Coat 1.2 30 E01 Remove/Install Energy absorber 0.0 Body 31 E01 Remove/Replace Glass Kit 1 26.80T Other 32 E01 Repair Adhesive Removal(per item) 0.1 Body 33 E01 Flex Additive 1 3.00T Other 34 E01 Repair Clean&retape(1/2 of R&I time) 0.1 Body 35 E01 Hazardous waste removal 1 3.00 Other 36 E01 Corrosion protection 0.3 Body 37 E01 PILLARS, ROCKER&FLOOR 38 E01 Remove/Install RT Rocker molding 0.8 Body 39 E01 Repair RT Rocker molding 0.5 Body 2.1 40 E01 Add for Clear Coat 0.4 41 E01 ROOF 42 E01 Remove/Install RT Molding 0.4 Body 43 E01 ROPE BACK GLASS MLDG 0.2 Body 44 E01 ROPE WINDSHIELD MLDG 0.2 Body 45 E01 Repair ROUGH PULL RT QTR AND WHEEL HOUSE 1.5 Body 46 E01 Blend RT Roof rail 0.8 Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$ Parts (28.31) 570.61 Labor, Body 42.00 25.0 1,050.00 Labor, Refinish 42.00 14.0 588.00 Material, Paint 350.00 Subtotal 2,558.61 Sales Tax 64.23 Grand Total 2,622.84 Insurer Prepaid Amount (2,418.09) Net Total 204.75 Estimate Version Total$ Original 2,622.84 Supplement S01 0.00 Insurance Total$: 204.75 Received from Insurance$: 143.50 STATE FARM INSURANCE COMPANIES 10/26/2012 143.50 Balance due from Insurance$: 61.25 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recor=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 1/25/2013 2:29:10 PM Page 2 HUBLER EXPRESS COLLISION - Workfile ID: 0338e25a Federal ID: 06-1805064 CARMEL State ID: 0126423717 INDIANA'S FIRST CHOICE IN COLLISION REPAIR! 503 W. CARMEL DR., CARMEL, IN 46032 Phone: (317) 569-9884 FAX: (317) 569-9885 Preliminary Supplement 1 with Summary RO Number: 11662 Written By: Eric Tobolski Insured: UNIT#77,CITY OF Policy#: Claim#: N/A CARMEL Type of Loss: Other Date of Loss: Days to Repair: 0 Point of Impact: 12 Front Owner: Inspection Location: Insurance Company: UNIT#77,CITY OF CARMEL HUBLER EXPRESS COLLISION-CARMEL SELF PAY 1 CIVIC SQ 503 W.CARMEL DR. CARMEL,IN 46032 CARMEL,IN 46032 (317)571-2559 Business Repair Facility (317)569-9884 Business VEHICLE Year: 2012 Body Style: 4D SED VIN: 2G1WD5E31C1285923 Mileage In: 9709 Make: CHEV Engine: 6-3.6L-FI License: 7229 Mileage Out: Model: IMPALA POLICE Production Date: 4/2012 State: IN Vehicle Out: 2/7/2013 Color: WHITE Int: BLACK Condition: Job#: TRANSMISSION Tinted Glass AM Radio 4 Wheel Disc Brakes Automatic Transmission Body Side Moldings FM Radio SEATS Overdrive Wood Interior Trim Stereo Bucket Seats POWER Dual Mirrors Search/Seek WHEELS Power Steering CONVENIENCE CD Player Styled Steel Wheels Power Brakes Air Conditioning Auxiliary Audio Connection PAINT Power Windows Rear Defogger SAFETY Clear Coat Paint Power Locks Tilt Wheel Anti-Lock Brakes(4) OTHER Power Driver Seat Cruise Control Driver Air Bag Traction Control Power Mirrors Intermittent Wipers Passenger Air Bag Stability Control Power Trunk/Tailgate Keyless Entry Head/Curtain Air Bags DECOR RADIO Front Side Impact Air Bags 2/7/2013 11:35:59 AM 024979 Page 1 RO Number: 11662 Preliminary Supplement 1 with Summary Vehicle: 2012 CHEV IMPALA POLICE 4D SED 6-3.6L-FI WHITE Line Oper Description Part Number Qty Extended Labor Paint Price$ 1 FRONT BUMPER&GRILLE 2 * Rpr Bumper cover w/o fog lamps 6_0 3.0 3 Add for Clear Coat 1.2 4 SO1 0/H front bumper 2.4 5 R&I R&I bumper cover Incl. 6 * R&I Upper grille black IDC—L 7 * R&I Lower grille black Inl 8 * R&I RT Bezel w/Police pkg Incl 9 * R&I LT Bezel w/Police pkg Ind. 10 # Flex Additive 1 3.00 11 # Two part bumper repair material 1 40.00 12 # Hazardous waste removal 1 3.00 X 13 ** S01 Repl A/M Energy absorber 15886100 1 168.00 Incl. 14 ** S01 Repl A/M CAPA Lower grille black 10333712 1 52.00 Incl. 15 # S01 R&I WIRING PUT IN FOR THE POLICE 0.5 PACKAGE SUBTOTALS 266.00 8.9 4.2 ESTIMATE TOTALS Category Basis Rate Cost$ Parts 263.00 Body Labor 8.9 hrs @ $48.00/hr 427.20 Paint Labor 4.2 hrs @ $48.00/hr 201.60 Paint Supplies 4.2 hrs @ $30.00/hr 126.00 Miscellaneous 3.00 Subtotal 1,020.80 Grand Total 1,020.80 2/7/2013 11:35:59 AM 024979 Page 2 Preliminary Supplement 1 with Summary RO Number: 11662 Vehicle: 2012 CHEV IMPALA POLICE 4D SED 6-3.6L-FI WHITE SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Labor Paint Price$ Changed It ms ,�- 3 R&I R&I bumper cover -1.4 5 S01 R&I R&I bumper cover Incl. 4 * R&I Upper grille black -0.2 6 * S01 R&I Upper grille black Incl. 5 * R&I Lower grille black -0.2 7 * S01 R&I Lower grille black Ind. 6 * R&I RT Bezel w/Police pkg -0.2 8 * Sol R&I RT Bezel w/Police pkg Ind. 7 * R&I LT Bezel w/Police pkg -0.2 9 * S01 R&I LT Bezel w/Police pkg Incl. Atliied Items - . r •-p �-:. _ -� k� _�- i�� '. 4 Sol O/H front bumper 2.4 13 ** Sol Repl A/M Energy absorber 15886100 1 168.00 Incl. 14 ** S01 Repl A/M CAPA Lower grille black 10333712 1 52.00 Incl. 15 # S01 R&I WIRING PUT IN FOR THE POLICE 0.5 PACKAGE SUBTOTALS 220.00 0.7 0.0 TOTALS SUMMARY Category Basis Rate Cost$ Parts 220.00 Body Labor 0.7 hrs @ $48.00/hr 33.60 Subtotal 253.60 Total Supplement Amount 253.60 NET COST OF SUPPLEMENT 253.60 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 767.20 Eric Tobolski Supplement S01 253.60 Eric Tobolski Job Total: $ 1,020.80 ***THIS IS A VISUAL DAMAGE EVALUATION ONLY.*** HIDDEN DAMAGE OR OMITTED DAMAGE BY THE ESTIMATOR IS NOT CALCULATED IN THIS REPORT. PART PRICES AND LABOR CHARGES MAY CHANGE AFTER A COMPLETE DISASSEMBLY AND REINSPECTION IS PERFORMED BY THE ESTIMATOR, TECHNICIAN, PARTS VENDORS, OR INSURANCE PERSONNEL. 2/7/2013 11:35:59 AM 024979 Page 3 ®� Carmel INDIANA RETAIL TAX EXEMPT PAGE �y CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000972 25U5 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,ASP CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION I IM12092 Hublef ExpFass Colli-gion Calmol Pollco D>apw#mont j VENDOR SHIP 3 Civic squam 603 Wort Cwmel Ddvo TO I Carmol, IN 46M Caffiicl„ IN 46032 �3�7�67R CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43.610.00 9 Eao repairs to vehiclo $767.20 $767.20 Sub Total: $767.26 ° n ��77 1 Rri Send Invoice To �� •° � C&MOI Police DeP artment Attn: Tema Anderson 3 Civic Squam amol, IN 46M2® PLEASE INVOICE IN DUPLICATE DEPARTMENT _ .a1•P1i�`l ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Police Dept. PAYMENT $767.20 �\ A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN •SHIP REPAID. THIS APPRppglgTlpN SUFFICIENT TO PAY FOR THE ABOVE ORDER. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. •PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. g •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE jih1of of Pollee AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 5)5- CLERK-TREASURER DOCUMENT CONTROL NO. A. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 _ IN THE SUM OF $ ON ACCOUNT OF APPROPRIATION FOR I • i Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I 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 I I JI I 20 � �_---------------- Signature------------ -- Title Cost distribution ledger classification if claim paid motor vehicle highway fund I 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)) 10/17/12 balance due/car 134- M. Miller $61.25 02/07/13 11662 car 77/Rodriguez $1,020.80 1 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 i VOUCHER NO. WARRANT NO. ALLOWED 20 Hubler Express Collision IN SUM OF $ 503 West Carmel Drive Carmel„ IN 46032 $1,082.05 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department i PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members Prior Year I hereby certify that the attached invoice(s), or 1110 43-510.00 $61.25 Encunibered bill(s) is (are) true and correct and that the 25545 11662 43-510.00 $1,020.80 materials or services itemized thereon for which charge is made were ordered and received except Friday, February 08, 2013 �Z' Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund