180819 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
l ONE CIVIC SQUARE GUARDIAN AUTO GLASS
i
4 CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $185.24
oa a CHICAGO IL 60673 -1243 CHECK NUMBER: 180819
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
.1110 4351000 21276 5205056592 185.24 WINDSHIELD REPLACEMEN
F :Y GUARDIAN AUTO CLASS
GUARDIAN 940 N SHADELAND AVE
A Company of Vision INDIANAPOLIS, IN 46219
(317)353 -6178 (800)882-2244
MVR# Y REMIT TO:
INVOICE Guardian Glass Company
WORK PERFORMED FOR: 24394 Network Place
CARMEL POLICE DEPT Chicago, IL 60673 -1243
3 CIVIC SQ Mtic1i3IC NbM131;R <l
CARMEL, IN 46032 5205056592
CARMEL POLICE DEPT 3ttfiO CB A E f1
Ri:
3 CIVIC SQ 12/08/2009
CARMEL, IN 46032 CLAIMANT:
L FEDERAL.TAX`:NIIMBER
34- 0801385
L___ LfigkritamstRmmL=.
5200080360
atER. it4TE
ACCOUNT: 121805 HP WP 12/07/2009
DMS 12/07/2009 08:00 05 :00 X I MARION
;iiOt4E:::#iiiONE WORx PHOH18 EY,T.. .D413'E`:<JY.tdS:S CAt)SH.blr.' <Lb.SS::::"::,: bEl}tICTrBLH;':
317 571 2548
AUTHORIZED. BY:......!.. i:: :'i .ACirNT S NAME ......i:. _.:..:.AGENT. ".::5..;:FHONE
ED
0OLTCY.; gtifiakt:::.....',. QYi Axm 4cQNTROS0.11ml ER. i.::::..: r c9.::JA .'.2JS/SSER
:STEKTCI:E Ib.: UMSEA LTQENS:EITIM NUMBER...;:.. MILEAGE:::: SA iES FERS N t TARIN 13Y::>
2G1WF55K659366504 /85 JAMES C LIPTON JWILLIAM
2005 CHEVROLET IMPALA 4 DOOR SEDAN
IIEORM :�?k":kAKbfEN�'
OPEN CHARGE REPEAT CUSTOMER
PART!NUMBER /DESCRIPT TOM: LIST PRICE UNIT PRICE TOTAL
1 DW01550GBYN Windshield (W /Third Visor Frit) 022 185.24
2 HAH000004 Urethane, Dam, Primer 0.00 0.00
SUBTOTAL 185.24
*STATEMENT OF AUTHORIZATION AND SATISFACTION
REPLACEMENT HAS BEEN MADE TO MY SATISFACTION AND I HEREBY AUTHORIZE THE ABOVE SALES TAX 0.00
INSURANCE COMPANY TO PAY DIRECT IN FULL TO GUARDIAN AUTO GLASS FOR SAID INSTALLATION.
IF FOR ANY REASON THE INSURANCE COMPANY DOES NOT PAY FOR THESE REPAIRS OR
REPLACEMENTS THE BELOW SIGNED AGREES TO PAY FOR SAID REPAIRS OR REPLACEMENTS. DEDUCTIBLE
SURFACE RUST OR CORROSION PRESENT AND TREATED NO WARRANTY AGAINST LEAKAGE WHEN CHECKED:
DATE CUSTOMER /WITNESS
185.24
"Safest Installation Always" TOTAL
4 li INDIANA RETAIL TAX EXEMPT PAGE
I' V uuu CERTIFICATE NO. 003120155 002 0 PURCHASE O 1 RDER NUMBER
Police DDepartment FEDERAL EXCISE TAX EXEMPT
35- 60000972 9 1 '77A
3ON, 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
naramhPr a, 200 windshield replacement
VENDOR Guardian. Auto Glass SHIP City of Cain el Police Department
940 N. Shadeland Avenue TO 3 Civic Squarew
Indianapolis, IN 46219 Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
windshield replacement for car 85 Semester 185024
A 4 4j .4,
k
7. (i Ili': 1 --T i
P
U'C:i Co og ij
Send Invoice To: f
PLEASE INVOICE I DUP LICATE
DEPARTMENT ACCOUNT PROJE PROJECT ACCOUNT AMOUNT
1110 510 auto repa�trs and mai.ntenaneP
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
,r f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ittP it. e O.Ir T' ,49,P J4
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
.t
CLERK- TREASURER
DOCUMENT CONTROL NO. A.P COPY SIGN AND RETURN TO CLERK'S OFFICE
VUCHER 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 except
20
Signature
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
Guardian Auto Glass Purchase Order No. 21276F
940 N. Shadeland Avenue Terms
Indianapolis, IN 46219 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/8/09 5205056592 payment for windshield replacement for car 85 185.24
Semester
Total
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
Guardian Auto Glass
IN SUM OF
24394 Network Place
Chicago, IL 60673 -1243
185.24
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
or INVOICE NO. ACCT #/TITLE AMOUN hereby certify invoice(s),
oEPr Po# I hereb certi that the attached or
21276F 5205056592 510 185 .24 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
December 15 20 09
Z
Signature
f
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund