186831 06/23/2010 *f CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN AUTO GLASS
CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $182.24
4+. CHICAGO IL 60673 -1243
CHECK NUMBER: 186831
CHECK DATE: 6123/2010
DEPARTMEN ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 26915 5205058943 182.24 WINDSHIELD REPLACEMEN
GUARDIAN A UTO GLASS
GUARDIAN 9 4 0 N SHADELAND AVE
ACompany o f Vision INDIANAPOLIS, IN 4 6219
(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 -1243
3 CIVIC SQ
CARMEL IN 46032 5205058943
CARMEL POLICE DEPT
IkCOCR :T]APE
3 CIVIC SQ 05/28/2010
CARMEL, IN 46032 CLAIMANT
�'E3�ER:AL TAxi� NUMBl"sR
34- 0801385
5200083671
CtRU�It' t11kTE
ACCOUNT: 121805 HP: WP: 05/25/2010
INST.'.:BY.::.: 'BS PROPOSER: C01PSTS3N :DAVE
IS'ZTE:'. 4igZT.. „i
DMS 05/27/2010 08:04 -05:0 X M- HAMILTON
317- 571 -2548
ROBERT
PO# 26915
E�tJGCLR: iD <NTTMBgFt,' DIGSNSE /:UNIT: ENV41Bl 4 b�SLEACsE SAiiES +ERSOI
2G1WF52KX59381222 ;JAMES C LIPTON BSCHRIER
Mi�ABL
2005 CHEVROLET IMPALA 4 DOOR SEDAN
E:..
k ORhfi: OF PAYiiE1E
OPEN CHARGE REPEAT CUSTOMER
PART.I'NUMB.ER /DESCRIPTION LIST PRICE :UNIT PRICE TOTAL
1 DWO155OGBYN Windshield (W /Third Visor Frit) 022 182.24
2 HM000004 Urethane, Darn, Primer 0.00 0.00
SUBTOTAL 1 &2%: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 R UST OR CORROSION PRES AND T NO WARRANTY AG AINS T LEAK WHEN CHE
DATE CUSTOMER /WITNESS
"Safest Installat Always" TOTAL
182.24
INDIANA RETAIL TAX EXEMPT PAGE
Cit of C armel CERTIFICATE N0.003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 26915
3§LNEZCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY,'OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
June 2 2000 windshield replacement
VENDOR Guardian AutoOGlass SHIP 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
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
windshield replacement for car 105 A Dawson 152.24
w
x T
�A'
n l� C1
Send Invoice To:
x4
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
1110 510 auto repairsoand maintenan AYMENT
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 UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
y
C -O.D. SHIPMENTS CANNOT BE ACCEPTED- ORDERED BY
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-
CLERK-TREASURER
DOCUMENT CONTROL No-26915 A.P.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# 9r 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____
2p
Signature
.Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescgbed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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
Guardioan Auto Glass Purchase Order No. 26915F
940 N. Shadeland Avenue Terms
Indianapolis, IN 46219 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/18/10 5205058943 payment for windshield replacement for car 105 Dawson 182.24
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.
o ALLOWED 20
G uardian Auto Glass IN SUM OF
940 N. Shadeland Avenue
'Indianapolis, IN
182.24
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or D PT. INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
26915F 5205058943 510 182.24 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
June 14 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund