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Home My WebLink About183307 03/16/2010 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 ONE CIVIC SQUARE GUARDIAN AUTO GLASS CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $212.92 trp c 2 CHICAGO IL 60673 -1243 CHECK NUMBER: 183307 CHECK DATE: 3!7612010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 21827 5205057459 212.92 WINDSHIELD G UARDIAN AUTO GLASS GUAR DIAN 940 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 (317)353-6178 (800)882-2244 MVR# Y REMIT TO: Guardian Glass Company INVOICE WORK PERFORMED FOR: 24394 Network Place CARMEL POLICE DEPT Chicago, IL 60673-2243 3 CIVIC SQ CARMEL, IN 46032 5205057459 CARMEL POLICE DEPT 3 CIVIC SQ 02/19/2010 CARMEL, IN 46032 CLAIMANT: A&:: NUMH '1 34-0801385 5 ACCOUNT: 121805 HP- WP. 02/18/2010 AT WE IN "CO&Lin DMS 02/18/2010 08:00-05:00 x I-MARION I I I _jw 317-571-2548 AGENT!:Sx: ROBERT PO# 21827 2GIWS57M591305689 IJAMES C LIPTON tSCHRI YEAR X: i: Doby.. 2009 CHEVROLET IMPALA 4 DOOR SEDAN OPEN CHARGE REPEAT CUSTOMER ST PRICE UNIT PRICE:....:: QTY L I X: :::..:::.:PART:�:NUMBERIDES47gTPT TOTAL 1 DWO164OGBYN windshield (W/Third Visor Frit) 022 212.92 2 RAH000004 Urethane, Dam, Primer 0.00 0.00 SUBTOTAL 212.92 ****STATEMENT OF AUTHORIZATION AND SATISFACTION"" REPLACEMENT HAS BEEN MADE TO NY 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 "Safest Installation Always" TOTAL 212.92 INDIANA RETAIL TAX EXEMPT PAGE CERTIFICATE NO. 003120155 002 0 i C a l PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 21$27 35- 60000972 3 Qf E 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 ORD= DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION February windshield VENDOR Guardian Alass SHIP City of Carmel Police Department 24394 Network Place TO 3 Civic Square Chicago, IL 60673 -1243 CariaAl, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION windshield replacement for car 4 Flaming 212.92 bb x A .e Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 11.10 510 auto repairseand maintenanc A/P 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 UINOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO CLERK TREASURER DOCUMENT CONTROL NO. A 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 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 ACCOUNTS PAYABLE VOUCHER City Farm No. 201 (Rev. 1995) 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. 21827F 940 N. Shadeland Avenue Terms Indianapolis, IN 46219 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2/19/10 5205057459 payment for windshield replacement 212.92 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 VOU0HER NO. WARRANT NO. ALLOWED 20 r Guardian Auto Glass IN SUM OF 940 N. Shadeland Avenue Indianapolis, IN 46219 212.92 ON ACCOUNT OF APPROPRIATION FOR police generla fund Board Members o PT INVOICE NO. ACCT #/TITHE AMOUNT I hereby certify that the attached invoice(s), or 21827E 5205057459 510 212.92 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 March 10 20 10 D Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund