HomeMy WebLinkAbout227884 1/9/2014 CITY OF CARMEL, INDIANA VENDOR: 358894 Page 1 of 1
ONE CIVIC SQUARE SAFELITE AUTOGLASS
CARMEL, INDIANA 46032 PO BOX 633197 CHECK AMOUNT: $256.89
CINCINNATI OH 45263-3197
„oCHECK NUMBER: 227884
CHECK DATE: 1/9/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4351000 01830-211288 256 . 89 AUTO REPAIR & MAINTEN
SAFELITE FULFILLMENT, INC.
CUSTOMER SERVICE CENTER 1-800-835-2257
AutoGlass IF YOU HAVE ANY QUESTIONS REGARDING
PAYMENT OF THIS INVOICE: 1-800-835-2092
INVOICE 01830-211288 INVOICE: 12/20/13 BD
__...__� . .. __.... ._. _. .,_._.__ _._ ._. _.. ORDERED: 12/16/13 INSTALLED: 12/20/13
PLEASE REMIT PAYMENT TO: W.O. # : 553075 REFERRAL#: 000000
SAFELITE FULFILLMENT, INC INSURED:
P.O. BOX 633197 CARMEL, CITY OF
CINCINNATI, OH 45263-3197 t 3400 W 131 ST
PLEASE WRITE INVOICE NUMBER ON CHECK s WESTFIELD IN 46074-0000
_. .____ _ __. ... ,.... . .._. ... ._ _... . PH1:317-733-2001 PH2:
CARMEL, CITY OF Acct #: 062398
3400 W 131 ST
WESTFIELD IN 46074
POLICY# PO#/REF
CLAIM # LOSS LOC:
AUTH/VER: JEFF LOSS DATE/CAUSE: 12/20/13
r 2005 GMC TOPKICK C85 2 DOOR CONV ARR: MOBILE
MILEAGE: 26, 116
VIN: 1GDP8C1C65F511830 LICENSE/ST: 27013 IN STOCK #: 105
QTY PART # LIST SELLING LABOR KIT MATERIAL EXTENSION
1 DW01519 GBN 218.57 183.69 50.00 .00 .00 233 .69
SOLAR
1 WFS D1265 SRM 18 .76 11.26 .00 . 00 .00 11.26
REVEAL
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
t
P A Y T H I S A M 0 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
010914-062398-062398 00590-062398-211288
CARMEL, CITY OF
3400 W 131 ST
WESTFIELD IN 46074 00001-566-EWYANT-954
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))
12/26/13 01830-553075 $256.89
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
Safelite Fulfillment, Inc.
IN SUM OF $
4625 W. 86th Street Suite 100
Indianapolis, IN 46268
$256.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 I z&iS30=-6&30Y-1e I 43-510.001 $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
,pesday,�,D ce� r 31, 1
Str8e,AbC.-oaLTi !99ffner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund