219355 04/24/2013 ZCITY OF CARMEL, INDIANA VENDOR 361690 Page 1 of 1
"` ONE CIVIC SQUARE HUBLER EXPRESS COLLISON
CARMEL, INDIANA 46032 603 W CARMEL DR CHECK AMOUNT: $1,488.22
_ CARMEL IN 46032 CHECK NUMBER: 219355
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 25659 11925 1, 488 . 22 REPAIRS
HUBLER EXPRESS COLLISION - won(flle it): 10113DU"
CARMEL
INDIANA'S FIRST CHOICE IN COLLISION REPAIR!
503 W. CARMEL DR., CARMEL, IN 46032
Phone: (317) 569-9884
FAX: (317) 569-9885
Final Bill
RO Number: 11925
Customer: Insurance: Adjuster: Estimator. Eric Tobolso
UNIT# 26,CITY OF CARMEL SELF PAY Phone: Create Date: 2/15/2013
1 CIVIC SQ Claim: N/A
CARMEL, IN 46032 Loss Date:
(317) 571-2559 Deductible:
Year: 2009 Style: 4D SED VIN: 2GlWS57MX91306661 Mileage In: 70993
Make: CHEV Color: WHITE Mileage Out,
Model: IMPALA POLICE License: 14237 Job Number: Vehicle Out: 4/8/2013
Line Ver Operation Description Qty Extended Type Labor Type Paint
Price$
1 E01 QUARTER PANEL
2 E01 Repair RT Quarter panel 5.0 Body 2.2
3 E01 Add for Clear Coat 0.9
4 E01 Remove/Install RT Qtr glass GM 1.5 Body
5 E01 glass kit 1 18.75 Other
6 E01 Remove/Replace RT Emblem flying impala 1 41.07 OEM 0.2 Body
7 E01 REAR LAMPS
8 ELI Repair RT Tail lamp assy 1.0 Body
9 E01 Remove/Install RT Tall lamp assy 0.4 Body
10 E01 Repair REMOVE DECAL 0.5 Body
11 E01 Remove/Install LOOSEN ROCKER MLDG 0.3 Body
12 E01 Hazardous waste removal 1 3.00 Other
13 E01 Corrosion protection 1 10.00 Other 0.2 Body
14 E01 Covercar 0.2
15 E01 Repair ROUGH PULL RT QTR 1.5 Body
16 E01 Repair TIE DOWN 0.5 Body
17 S01 REAR BUMPER
18 S01 Remove/Install R&I bumper cover 1.5 Body
19 S01 Repair Bumper cover w/dual exh 2.5 Body 3.0
20 Sol Add for Clear Coat 1.2
21 SOS ROOF
22 S01 Remove/Install RT Molding 0.4 Body
23 S01 Blend RE Roof Rail 0.8
24 S01 Remove/Install ROOF LIGHT BAR 0.5 Body
T=Taxable Item,Pro=Related Prior Damage,AA=Appeamuce Allowance,UPD=Unrelated Prior Damage,PER=Pamtless Dent Repair,AIM=Aftermarket, Rehr=Rechromed,Reman=
Remanufactured,OEM=New original Equipment Manufacture,Recor=Re-cored,LKQ=Uke Kmd Quality or Used,Dag=Diagnosbc,Elec= Electrical, Mech =Mechanical,Ref=Refinish,Sbruc=
smocturai
4)8/2013 1:33:24 PM Page 1
renal bill
RO Number: 11925
Vehicle: 2009 CHEV IMPALA POLICE 4D SED 6-3.9L-FI WHITE
Estimate Totals Discount$ Markup$ Rate$ Total Hours Total$
Parts 72.82
Labor, Body 48.00 16.0 768.00
Labor, Refinish 48.00 8.3 398.40
Material, Paint 249.00
Subtotal 1,488.22
Sales Tax 0.00
Grand Total 1,488.22
Net Total 1,488.22
Estimate Version Total $
Original 887.02
Supplement S01 601.20
Insurance Total $: 0.00
Received from Insurance $: 0.00
Balance due from Insurance$: 0.00
Customer Total $: 1,488.22
Received from Customer$: 0.00
Balance due from Customer$: 1,488.22
T=Taxable Item,RPD=Related Poor Damage,AA=Appearance Allowance,UPD=Unrelated Poor Damage,PDR=Paintless Dent Repair,AIM=Aftermarket,Rechr=Rechromed,Reman=
Remanufactured,OEM=New original Equipment Manufacturer,Recor=ReKOred,LKQ=like Kind Quality or Used,Dlag=Diagnostic,Elec=[tectncal,Mech=Mechanical, Ref=Refinish,Souc=
structural
4/8/2013 1:33:24 PM Page 2
City Carmel INDIANA RETAIL TAX EXEMPT PAGE
of CERTIFICATE NO.003120155 002 0 llll PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 25659
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES.ATP
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
311f1013
Hubler Express Collision Carmel Police Department
VENDOR SHIP 3 Civic Square
TO
503 West Carmel Drive Carmel, IN 48032
Cannel„ IN 46032 (317)571-2%9
CONRRWnON BLANKET CONTRACT PAYMENT TERMS FREIGHT
OUANPTY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43.610,00
1 Each repairs to vehicle $887.02 $887.02
Sub Total: $887.02
4t
}�Y • � � a : S'"I
• o
car 26/Leach �Q �%� ��
Send Invoice To:
Carmel Police Department
Attn: Teresa Anderson
3 Civic Square
Cannel, IN 48032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Cannel Police Dept. K 111:� PAYMENT 97.02
• AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION,SUFFICI�OR THE ABOVE ORDER
•SHIP REPAID.
•Co D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL V
SHIPPING LABELS
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE R 1 BP of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO
['J 6 5 V CLERK-TREASURER
DOCUMENT CONTROL NO. A.P. . COPY-SIGN AND RETURN TO CLERK'S OFFICE -
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT T
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
City Form No.201 (Rev. 1995)
Presa,bed by Slate Board of Accounts
ACCOUNTS PAYABLE VOUCHER
20� CITY OF CARMEL
N SUM OF $
An invoice or bill to be properly itemized must show. kind of service, where performed, dates service rendered, by
day, number of hours, rate per hour, number of units, price per unit, etc
whom, rates per
Payee
Purchase Order No.
Terms
Date Due
�— I Description Amount
Invoice e attached invoice(s) or bill(s))
Date
Qoar;.l rvlembers repairs to car 26/L each $1,48822
04/08/13
..red lnvnirct�' nr
I hereto y cer'ythat hPCOrrect and that the
(are) true and thereon�,.
ml�i�s or 5eNices lY�e ordered and r
made
which t-targe is
d except
i
i
S� •'hursday, April 18, 2013
Chief of Police
Title
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
I
VOUCHER NO, WARRANT NO F�
Hubler Express Collision
503 West Carmel Drive
ICarmel„ IN 46032
I $1,48822
ON ACCOUNT OF APPROPRIATID FOP-
Carmel Police DepartmE—�-- Ott
PO#/Deot INVOICE NO ACCT#ITITLE AMOVN j
25659 I 11925 I 43-510-00•
I
I
I
Cost distribution ledger
claim paid motor vehicl
R .
n
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))
04/08/13 11925 repairs to car 26/Leach $1,488.22
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. WARRANT NO. _
ALLOWED 20
Hubler Express Collision
IN SUM OF $
503 West Carmel Drive
Carmel„ IN 46032
$1,48&22
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept INVOICE NO ACCT#(TITLE AMOUNT Board Members
25659 11925 43-51000 $1,48822 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
Thursday, April 18, 2013
/ Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund