191660 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN GLASS COMPANY
CHECK AMOUNT: $186.48
CARMEL, INDIANA 46032 24394 NETWORK PLACE
CHICAGO IL 60673 -1243 CHECK NUMBER: 191660
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 27057 5205060819 186.48 WINDSHIELD REPLACEMEN
1:M_ I GUA RDIAN AUTO GLASS
GUARDIAN 940 N SHADELAND AVE
A Company of Vision INDIANAPOLIS, IN 46219
REMIT T0:
(317 )353 ^6178 (800)882 -2244 Guardian Glass Company
MVR# Y 24394 Network Place
Chicago, IL 60673 -1243
INVOICE WORK PERFORMED FOR:
CARMEL POLICE DEPT 11/24/2010
3 CIVIC SQ
CARMEL POLICE DEPT CARMEL, IN 46032 5205060819
3 CIVIC SQ 10/25/2010
CARMEL, IN 46032 CLAIMANT
;:FEBB�P.Y, TP:�':iNUMBERs:
34- 0801385
5200086291
ACCO=: 121505 HP: WP: 10/21/2010
tA1ST ByC.1!TS;. SY .'ROp45EF1:flMPLETi]t�.1)1C23Y: MQ.:.#1 WE: TH .sl?ii. ..3P 5:. #?:E,E 2AIT
DMS 10/22/2010 08:00 05:0 X M H AMILTO N
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04
317- 571 -2548
ROBERT
PO #.27057
SfEHYCIE'::I�#.;iGClM 1+ZGE75E :UT.=:I7[JISHIiIti'. b2TIrEAGE. ;:5:#kESRTRS(A#..
2G1WD5EMZA,1225512 /44 JAMES C LIPTON JWILLIAM
SQbY..Sly#,�.
2010 CHEVROLET IMPALA 4 DOOR SEDAN
FORDfi .CJF.kRYNE
OPEN CHARGE ROBERETCUSTOMER
QTY PART "NUMBER /BESCRIPTION LIST. :PRICE UNIT PRICE:
TOTAL
1 DWO164OGTYN Windshield (W /Third Visor Nrit) 022 186.48
2 HAH000004 Urethane, Dam, Primer 0.00 0.00
SUBTOTAL -18 6 4 8:
*STATEMENT OF,'- AUTHORIZATION AND SATISFACTION
REPLACEMENT HAS BEEN MADE TO MY SATISFACTION AND I HEREBY AUTHORIZE THE ABOVE SALES TAX 0.00
INSURANCE. 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 AG AIN S T L EAKAGE WHE CHECKED: E]
DATE CUSTOMER /WITNESS
"Safest installation... Always" TOTAL 186.48
lt INDIANA RE TAX EXEMPT PAGE 1 of 1
J l r J I'� CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 2 705
3M CIVIC 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.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
October 21 701 windshield replacement
VENDOR Guardian Glass Co SHIP City of Carmel Police Department
24394 Network Place TO 3 Civic Square
Chicago, EL 60673- -1243 Carmel, IN 46032
ti
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
replacement windshield for car 44 Robbins 186048
U
j
4 t v
o 3 r
4- �l
7
Send Invoice To: 1
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 510 auto repairs and ma tenancpe
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 PROP R SWORN AFFIDAVITATTACHED,
SHIPPING INSTRUCTIONS I HEREBY CERTIFYTH HERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID,
THIS APPROPRIA N F ICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. 9'
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. Assistant Chief of P o l iee
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL No-27057 A.P .V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.- WARRANT NO.____
ALLOWED 20
IN THE SUM OF
f1s
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 it
claim paid motor vehicle highway fund
Prescribed 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
Guard ian`°- .G�lassGCompany Purchase Order No. 27057F
24394 Network Place Terms
Chicago, IL 60673 -1243 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/25/1 5205060819 payment for windshield replacement for car 44 Robbi s 186.48
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
Guar Glass Company
IN SUM OF$
24394 Network Place =j
CC 606 73-1243
186.48
ON ACCOUNT OF APPROPRIATION FOR
police genera lfund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
27057F 5205060819 510 186.48 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
November 4 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund