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Home My WebLink About181565 01/20/2010 .5 P CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 i II i. ONE CIVIC SQUARE GUARDIAN AUTO GLASS CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $202.64 II,:• CHICAGO IL 60673-1243 CHECK NUMBER: 181565 CHECK DATE: 1/20/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 21311 5205056876 202.64 WINDSHIELD -CAR 24 GUARDIAN AUTO CLASS GUARDIAN 940 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 317)353-6178 800)882-2244 MVR# REMIT TO: Y INVOICE WORK PERFORMED FOR: Guardian Glass Company 24394 Network Place CARMEL POLICE DEPT Chicago, IL 60673-1243 1 3 CIVIC SQ CARMEL, IN 46032 5205056876 CARMEL POLICE DEPT 3 CIVIC SQ 01/05/2010 CARMEL, IN 46032 CLAIMANT: 1. 34 0801385 PRPER:;143.714BER.:: 5200080751 ACCOUNT: 121805 HP: WP: 01/04/2010 MIST: PROR0,58Lr:CeitaitrIng: :1) ATE :PR :WAJT DMS 01/04/2010 08:00-05:00 X I HAOME:,RHURMV 317-571-2548 JASON LATM/UONTROL:NtIMPiER:r===r0WEdn4U 4gLaPtgO.W:h: 2G1WS583281354627 JAMES C LIPTON JLIPTON. 2008 CHEVROLET IMPALA 4 DOOR SEDAN FORM .0FPAYMEWL OPEN CHARGE REPEAT CUSTOMER H PART-NUMBER/DESCRIPTION LIST 'PRICE:,.UNIT PRICE 1 DW01640GTYN Windshield (W/Third Visor Frit.) 177 202.64 2 HAH000004 Urethane, Dam, Primer 0.00 0.00 t SUBTOTAL 202.64 ****S ur AUTHOnIZATION 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: 0 DATE CUSTOMER/WITNESS 202.64 "Safest Installation Always" TOTAL 1 0 INDIANA RETAIL TAX EXEMPT PAGE CERTIFICATE NQ. 003120155 002 0 1 of 1 P URCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 21311 301E:CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FOAM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION January 5, 2010 windshield replacement VENDOR Guardian Auto G.ss SH IP City of Carmel Police Department 940 N. Shadeland Avenue T O 3 Civic Square Indianapolis, IN 46219 Carmel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT I QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION replace windshield for car 24 R. Harris 202.64 i -,4_ .8 4 s j toe F«),.5$ c;'¢„ :1127 's to cr -4''''.' 4 Send invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1110 510 auto repairs and mint nancpAYMENT AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO. 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 v THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER SHIP REPAID. C.O.D. SHIPMENTS CANNOT BE ACCEPTED j R C. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY .k? /6/7H: s i f 1) f 77 SHIPPING LABELS r THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police w AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 1 21311 CLERK TREASURER DOCUMENT CONTROL NO. A. v. 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 #TTITLE 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 it 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. 21311F 940 N. Shadeland Avenue Terms Indianapolis, IN 46219 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1/5/10 5205056876 payment for repairs to windshield for car 24 202.64 Total 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 G Auto Glass IN SUM OF 940 N. Shadeland Avenue Indianapolis'; IN 46219 202.64 ON ACCOUNT OF APPROPRIATION FOR police general fund Board Members DEPT. Po# ar NO. I NVOICE NO ACCT #/TITLE AMOUNT hereby certify f I that the attached invoice(s), or 21311F 5205056876 510 202.64 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 January 13 20 10 t._ Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund