HomeMy WebLinkAbout225962 11/05/2013 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS CHECK AMOUNT: $256.89
CARMEL, INDIANA 46032 PO BOX 633197
CINCINNATI OH 45263-3197 CHECK NUMBER: 225962
CHECK DATE: 11/5/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 01830-208773 256 . 89 AUTO REPAIR & MAINTEN
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: 1-800-835-2092
INVOICE 01830 -208773 INVOICE: 10/28/13 BD
ORDERED: 10/23/13 INSTALLED: 10/28/13
PLEASE REMIT PAYMENT TO: W.O. # : 544501 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL FIRE DEPT
CINCINNATI, OH 45263-3197 2 CIVIC SQUARE
PLEASE WRITE INVOICE NUMBER ON CHECK CARMEL IN 46032-0000
PH1:317-571-2600 PH2:
CARMEL FIRE DEPT Acct #: 160295
2 CIVIC SQUARE
CARMEL IN 46032
POLICY# : PO#/REF : 421
CLAIM # : LOSS LOC:
AUTH/VER: JASON LOSS DATE/CAUSE: 10/28/13
------------------------------------------------------------------------------------
---- --------- ----------------
2011 FORD F SERIES F150 4 DOOR CREW ARR: MOBILE
MILEAGE: 49, 853
VIN: 1FTFW1ET2BKD86932 LICENSE/ST: 6371 IN STOCK #: 421
-- - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DWO1747 GTYOEE 234.99 194.95 50.00 .00 .00 244.95
SOLAR-W/THIRD VISOR FRIT
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 194.95
LABOR TOTAL 61.94
SUB-TOTAL 256.89
SALES TAX 0.00
P A Y T H I S A M O U N T 256.89
TERMS- NET 30
ADDITIONAL INFO/CLAIMANT SERVICED BY: COUNTY/A
SAFELITE AUTOGLASS # 01830
INDIANAPOLIS IN 46268-0000
SAFELITE TAX ID #: 36-4523816
102813-160295-160295 00513-160295-208773
CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032 20131028 0000000020131028742
VOUCHER NO. WARRANT NO.
ALLOWED 20
Safelite Auto Glass
IN SUM OF $
P.O. Box 633197
Cincinnati, OH 45263
$256.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
r
1120 I 01830-208773 I 43-510.00 I $256.89 1 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
NOV 42013
d
i
Fire Chief
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))
01830-208773 VIN 6932 $256.89
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