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Home My WebLink About218090 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 361690 Page 1 of 1 t ONE CIVIC SQUARE HUBLER EXPRESS COLLISON 503 W CARMEL DR CHECK AMOUNT: $4,976.83 CARMEL, INDIANA 46032 CARMEL IN 46032 CHECK NUMBER: 218090 CHECK DATE: 3/13/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 11254 662 . 27 AUTO REPAIR & MAINTEN 1110 R4351000 26234 11254 498 . 20 REPAIRS TO VEHICLE 1110 4351000 25607 11737 994 . 80 REPAIRS 1110 4351000 11764 1, 693 . 15 AUTO REPAIR & MAINTEN 1110 R4351000 26239 11768 1, 128 .41 REPAIRS TO CAR 115 HUBLER EXPRESS COLLISION - worKrlle iu: ibebSy/z CARMEL INDIANA'S FIRST CHOICE IN COLLISION REPAIR! 503 W. CARMEL DR., CARMEL, IN 46032 Phone: (317) 569-9884 FAX: (317) 569-9885 Final Bill RO Number: 11764 Customer: Insurance: Adjuster: Estimator: Eric Tobolski TROYER, DARIN SELF PAY Phone: Create Date: 2/25/2013 3 CIVIC SQ Claim: N/A CARMEL,IN 46032 Loss Date: (317) 571-2559 Deductible: Year: 2013 Style: 4D UTV VIN: 5N1AR2MM9DC636094 Mileage In: 646 Make: NISS Color: BLACK Mileage Out: Model: PATHFINDER 4X4 SV License: 129LMG Job Number: Vehicle Out: 3/7/2013 Line Ver Operation Description Qty Extended Type Labor Type Paint Price$ 1 E01 QUARTER PANEL 2 E01 Repair RT Quarter panel 8.0 Body 2.2 3 E01 Add for Clear Coat 0.9 4 E01 Remove/Install RT Quarter glass Nissan 1.4 Body 5 Sol glass kit 1 18.75 Other 6 E01 REAR LAMPS 7 E01 Remove/Replace RT Tail lamp assy 1 142.70 OEM 0.3 Body 8 E01 REAR BUMPER 9 E01 Remove/Replace RT Side bracket(HSS) 1 35.33 OEM 0.1 Body 10 E01 0/H rear bumper 1.6 Body 11 E01 Remove/Replace Bumper cover w/reverse sensor, w/o 1 319.37 OEM 0.0 Body 3.0 trailer pkg 12 E01 Add for Clear Coat 1.2 13 E01 Add for reverse Sens 0.4 Body 14 E01 Flex Additive 1 3.00 Other 15 E01 Hazardous waste removal 1 3.00 Other 16 E01 Corrosion protection 1 10.00 Other 0.2 Body 17 E01 I Cover car 0.2 Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$ Parts 532.15 Labor, Body 48.00 12.0 576.00 Labor, Refinish 48.00 7.5 360.00 Material, Paint 225.00 Subtotal 1,693.15 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket, Rechr=Rechromed,Raman= 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 3/7/2013 3:41:19 PM Page 1 rinai esm RO Number: 11764 Vehicle: 2013 NISS PATHFINDER 4X4 SV 4D UTV 6-3.5L-FI BLACK Sales Tax 0.00 Grand Total 1,693.15 Net Total 1,693.15 Estimate Version Total$ Original 1,693.15 Supplement S01 0.00 Insurance Total $: 0.00 Received from Insurance $: 0.00 Balance due from Insurance$: 0.00 Customer Total $: 1,693.15 Received from Customer$: 0.00 Balance due from Customer$: 1,693.15 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M =Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recor=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 3/7/2013 3:41:19 PM Page 2 HUBLER EXPRESS COLLISION - Workfile ID: f82e8c10 CARMEL INDIANA'S FIRST CHOICE IN COLLISION REPAIR! 503 W. CARMEL DR., CARMEL, IN 46032 Phone: (317) 569-9884 FAX: (317) 569-9885 Final Bill RO Number: 11768 Customer: Insurance: Adjuster: Estimator: Eric Tobolski UNIT# 115,CITY OF CARMEL SELF PAY Phone: Create Date: 11/29/2012 1 CIVIC SQ Claim: N/A CARMEL,IN 46032 Loss Date: (317)571-2559 Deductible: Year: 2012 Style: 4D SED VIN: 2G1WD5E30C1154126 Mileage In: 14721 Make: CHEV Color: WHITE Mileage Out: Model: IMPALA POLICE License: 6360 Job Number: Vehicle Out: 3/1/2013 Line Ver Operation Description Qty Extended Type Labor Type Paint Price$ 1 E01 REAR BUMPER 2 E01 0/H rear bumper 1.9 Body 3 E01 Remove/Replace Bumper cover w/dual exh 1 526.63 OEM 0.0 Body 3.0 4 E01 Add for Clear Coat 1.2 5 E01 Flex Additive 1 3.00 Other 6 E01 Hazardous waste removal 1 3.00 Other 7 SO1 Remove/Replace Energy absorber 1 176.98 OEM 0.0 Body Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$ Parts 709.61 Labor, Body 48.00 1.9 91.20 Labor, Refinish 48.00 4.2 201.60 Material, Paint 126.00 Subtotal 1,128.41 Sales Tax 0.00 Grand Total 1,128.41 Net Total 1,128.41 Estimate Version Total$ Original 951.43 Supplement S01 176.98 Insurance Total$: 0.00 Received from Insurance$: 0.00 Balance due from Insurance$: 0.00 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recor=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 3/1/2013 4:09:06 PM Page 1 Final Bill RO Number: 11768 Vehicle: 2012 CHEV IMPALA POLICE 4D SED 6-3.6L-FI WHITE Customer Total$: 1,128.41 Received from Customer$: 0.00 Balance due from Customer$: 1,128.41 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,Rechr=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 3/1/2013 4:09:06 PM Page 2 HURLER EXPRESS COLLISION — WOrKille iu: JgJbD4.i0 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: 11737 Customer: Insurance: Adjuster: Estimator: Eric Tobolski UNIT# 135,CITY OF CARMEL SELF PAY Phone: Create Date: 1/18/2013 1 CIVIC SQUARE Claim: N/A CARMEL,IN 46032 Loss Date: (317) 571-2559 Deductible: Year: 2009 Style: 4D SED VIN: 2G1WS57M891308487 Mileage In: 59660 Make: CHEV Color: SILVER Mileage Out: Model: IMPALA POLICE License: 14210 Job Number: Vehicle Out: 2/20/2013 Line Ver Operation Description Qty Extended Type Labor Type Paint Price$ 1 E01 FRONT BUMPER&GRILLE 2 E01 Overhaul 0/H bumper assy 2.4 Body 3 E01 Remove/Replace Bumper cover w/o fog lamps 1 250.00 A/M 0.0 Body 3.0 4 E01 Add for Clear Coat 1.2 5 E01 Remove/Replace Energy absorber 1 168.00 A/M 0.0 Body 6 E01 Remove/Replace Upper grille w/o SS 1 70.00 A/M 0.0 Body 7 E01 Remove/Replace Lower grille w/o SS 1 58.00 A/M 0.0 Body 8 E01 Hazardous waste removal 1 3.00 Other 9 E01 Flex Additive 1 3.00 Other Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$ Parts 552.00 Labor, Body 48.00 2.4 115.20 Labor, Refinish 48.00 4.2 201.60 Material, Paint 126.00 Subtotal 994.80 Sales Tax 0.00 Grand Total 994.80 Net Total 994.80 Estimate Version Total$ Original 994.80 Insurance Total $: 0.00 Received from Insurance $: 0.00 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recor=Re-cored,LKQ=Like Kind Quality or Used, Diag=Diagnostic,Elec=Electrical, Mech=Mechanical,Ref=Refinish,Struc= Structural 3/7/2013 3:40:10 PM Page 1 rinall esni RO Number: 11737 Vehicle: 2009 CHEV IMPALA POLICE 4D SED 6-3.9L-FI SILVER Balance due from Insurance$: 0.00 Customer Total $: 994.80 Received from Customer$: 0.00 Balance due from Customer$: 994.80 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,AIM =Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer,Recur=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic,Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 3/7/2013 3:40:10 PM Page 2 HURLER EXPRESS COLLISION - worKrlle iu: eiizasae CARMEL INDIANA'S FIRST CHOICE IN COLLISION REPAIR! 503 W. CARMEL DR., CARMEL, IN 46032 Phone: (317) 569-9884 FAX: (317) 569-9885 Final Bill RO Number: 11254 Customer: Insurance: Adjuster: Estimator: Eric Tobolski CARMEL POLICE DEPARTMENT AMERIPRISE AUTO&HOME Phone: Create Date: 10/23/2012 3 CIVIC SQUARE Claim: 1553054 CARMEL,IN 46032 Loss Date: (111) 111-1111 Deductible: Year: 2012 Style: 4D SED VIN: 2G1WD5E33C1150054 Mileage In: 13555 Make: CHEV Color: Black Mileage Out: Model: IMPALA POLICE License: 976KAV Job Number: Vehicle Out: 11/19/2012 Line Ver Operation Description Qty Extended Type Labor Type Paint Price$ 1 E01 Control#1387238 2 E01 Claim#1553054 3 E01 REAR BUMPER 4 E01 O/H rear bumper 1.9 Body 5 E01 Remove/Replace Bumper cover w/dual exh 1 526.63T OEM 0.0 Body 3.0 6 E01 Add for Clear Coat 1.2 7 E01 Flex Additive 1 3.00T Other 8 E01 Hazardous waste removal 1 3.00 Other 9 S01 Remove/Replace Energy absorber 1 163.87T OEM 0.0 Body Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$ Parts 696.50 Labor, Body 46.00 1.9 87.40 Labor, Refinish 46.00 4.2 193.20 Material, Paint 126.00 Subtotal 1,103.10 Sales Tax 57.37 Grand Total 1,160.47 Net Total 1,160.47 Estimate Version Total$ Original 985.12 Supplement S01 175.35 Insurance Total $: 1,160.47 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Reman= Remanufactured,OEM=New Original Equipment Manufacturer, Recor=Re-cored,LKQ=Like Kind Quality or Used,Diag=Diagnostic, Elec=Electrical,Mech=Mechanical,Ref=Refinish,Struc= Structural 3/7/2013 3:42:05 PM Page 1 rinai tsm RO Number: 11254 Vehicle: 2012 CHEV IMPALA POLICE 4D SED 6-3.6L-FI Black Received from Insurance$: 0.00 Balance due from Insurance$: 1,160.47 Customer Total $: 0.00 Received from Customer$: 0.00 Balance due from Customer$: 0.00 T=Taxable Item,RPD=Related Prior Damage,AA=Appearance Allowance,UPD=Unrelated Prior Damage,PDR=Paintless Dent Repair,A/M=Aftermarket,Rechr=Rechromed,Remain= 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 3/7/2013 3:42:05 PM Page 2 City0 INDIANA RETAIL TAX EXEMPT PAGE o Jl Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P 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 2 M013 Hublor Express Collision Cannel Pollco Dopartment VENDOR TOIP 3 CIVIC square 503 West CI a iel Drive Carmel, IN -4 �a Marrnol„ IN 4M (317)5 gg 82mg CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account -611.00 1 Each repairs to vehicle $1,693.15 $1,693.15 Sub Total: $1,693.15 N. °K�..✓. .`40, !: � it ��= Send Invoice To: Cannel Police Department Attn: Teresa Anderson 3 Civic Squam Carmel, IN 2- PLEASE INVOICE IN DUPLICATE DEPARTMENT t ACCOUNT PROJECT PROJECTACCOUNT AMOUNT Carmel Police Dept. t --�� PAYMENT �'I,693.15 i A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND • VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION'SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /{ •PURCHASE ORDER NUMBER MUST APPEAR ON ALL /C' hief SHIPPING LABELS. p�THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE o/�9 Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2;j 2 CLERK-TREASURER DOCUMENT CONTROL NO. A. . . COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO WARRANT NO. ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR 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 20 ............................................................................................................................................................._..................-- ._.... Signature ......................................................................................................................--............................_._................ .......-.- Title Cost distribution ledger classification if claim paid motor vehicle highway fund I •�,�;,.•� -. 0 '. ,.. INDIANA RETAIL TAX EXEMPT PAGE ®f Car"' � CERTIFICATE NO.003120155 002 0 C i � PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000972 , THIS NUMBER MUST APPEAR ON INVOICES,A/P ONE CIVIC SQUARE 'r ,� CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERYFMEMO, PACKING SLIPS, / 3 n. SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS.,FOR CITY OF CARMEL- 1997 ' ryF 'UUR�CydHASSEE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION iYD�1¢G 2 Hubl®rExpfos%Collision °=` Cmial Ponce Dopartment VENDOR SHIP 3 Civic Bqr;m SM Mat C 1�1 �FQt��- :;"., TO Carmel, IN 46 - Ca,oi„ IN 48M 571-26% CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43.610.00,,' 9, Eat repairs 90 vehicle '"' $549.60 $549.60 9 Each repairs to s®hide i $921.35 $921.55 Sub Total: $9,463.95 Send Invoice Carmol Pollce Dgpikmont Attn:Tmom Ander6on 3 Civic Oqumro Carmel, IN. 46=- _ r PLEASE INVOICE IN DUPLICATE I : DEPARTMENT $ ` 4_„ _ `4CCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. ::' t '� PAYMENT $9.+x•15 ;- • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. •...,,, NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT IHERE IS AN UNOBLIGATED BALANCE IN ' THIS APPROPRIATION SUFFICIENT TO PAY FOR THE.ABOVE ORDER. •SHIP REPAID. -_- •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. .•PURCHASE ORDER NUM _ BER MUST APPEAR ON ALL _ — ORDERED BY SHIPPING LABELS. ,y R THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE "�1,le 0Y Police. - AND ACTS AMENDATORY THEREOF AND-SUPPLEMENT THERETO. V ' a �� CLERK-TREASURER DOCUMENT CONTROL-NO.2 6 27 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO WARRANTND�___- ALLOWED 20___ |N THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR ^ - Board Members PO#or INVOICE NO. ACCT#MTLE' AMOUNT DEPT# | hereby certify that the attached invoioe(s)' nr bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and neceived �xce[�__ ' ' - . ` 20____ ' __________ � Signature Title Cost distribution ledger classification if ' � claim paid rnom,vehicle highway fund ' INDIANA RETAIL TAX EXEMPT PAGE City ®f, Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT S 35-60000972 2M7 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION '1118M3 Hublor Expmss Collision Carmel Police Department VENDOR SHIP 3 CIVIC Square TO 503 Mot Camel Drlvo Carmel, IN 46032 Carmel„ IN 46032 (W)157 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY gA UNIITOF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43.6 F040 9 Each repairs to vehicle $994.80 $994.80 Sub Total; $fl94.80 < ' Send°Invoice `"r Carmel Police Department Attn:Teresa Anderson 3 Civic Squam Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. r"` � PAYMENT $M.80 �. A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. •PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �•� i' '�-,!a'.trl SHIPPING LABELS. •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 4- j'af df PaII A AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. r%Z- 2 b'0 CLERK-TREASURER DOCUMENT CONTROL NO. A. • COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO..--_-_---WARRANT ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR 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....----------..-----.--.-_--.- -- 20 ............................................_...................-...........................----....._............................................... -.........._.................. . Signature . -............_._................. Title Cost distribution ledger classification if claim paid motor vehicle highway fund 0 INDIANA RETAIL TAX EXEMPT PAGE City ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 2 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P 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. 'URCHASE ORDER DATE ' DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 8/i7=2 bublor Enpross Collision Carmol Pollco Dopartmont VENDOR SHIP 3 Civic Square TO SM West Camol Drive Camel, IN 48132 C2mol„ IN 4M (317)671 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43.590.00 9 Each repairs 4o vehicle $498.20 $408.20 Sub Total: $498.20 �,, •1 spa' wm ft Send Invoice 1'b: e Camel Polico Depadment Alan: Teresa Anderson 3 Civic Squara Carmel, IN 41 m PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT t Carmel Police Dept. PAYMENT $498.20 • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT Tf ERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. • •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY •PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. Zr THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE io4 of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 2 6 2 3 4 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT ALLOWED 20 IN THE SUM OF$ S ON ACCOUNT OF APPROPRIATION FOR 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.........................._.._..---.._..........----- 20 ...................._.......... Signature ...........----............ --.._......................................_.....-- ..................................... Title Cost distribution ledger classification if, claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 Hubler Express Collision IN SUM OF $ 503 West Carmel Drive Carmel„ IN 46032 $4,976.83 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members Prior Year I hereby certify that the attached invoice(s), or 1110 11254 43-510.00 $662.27 Prior Year Encumbered bill(s) is (are) true and correct and that the 26234 11254 43-510.00 $498.20 materials or services itemized thereon for 25607 11737 43-510.00 $994.80 which charge is made were ordered and Encumbered 26239 11768 43-510.00 $1,128.41 received except --2les� 11764 43-510.00 $1,693.15 Thursday, March 07, 2013 Chief of Police Title Cost distribution ledger classification if claim paid motor 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 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)) 11/19/12 11254 vehicle repairs $662.27 11/19/12 11254 vehicle repairs $498.20 02/20/13 11737 vehicle repairs $994.80 03/01/13 11768 repairs to car 115/Theis $1,128.41 03/07/13 11764 vehicle repairs $1,693.15 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