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HomeMy WebLinkAbout196365 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC CHECK AMOUNT: $198.57 CARMEL, INDIANA 46032 24394 NETWORK PLACE CHICAGO IL 60673 -1243 CHECK NUMBER: 196365 CHECK DATE: 4/13/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 27760 5205062630 198.57 WINDSHIELD REPAIR [go GUARDIAN AUTO GLA LLC GUARDIAN 940 N SHADELAND AVE ACompany of V ision INDIANAPOLIS, IN 4 6219 REMIT T0: (317)353 -6178 (800)882 -2244 Guardian Auto Glass, LLC MVR# Y 24394 Network Place Chicago, IL 60673 -1243 INVOICE WORK PERFORMED FOR: ,hxrEf� .tiv DATE CARMEL POLICE DEPT 04/27/2011 3 CIVIC SQ iNOTCE "N{1MEER CARMEL POLICE DEPT CARMEL, IN 46032 5205062630 >..INV 3 CIVIC SQ 03/28/2011 CARMEL, IN 46032 CLAIMANT: Pf�1��TtAL .1`A %.i i�7UMEER 27- 3440978 5200088705 ACCOUNT: 121805 HP: WP: 03/24/20il Ibi5 BY zNST 3C PROPOSEti.. OMPI A E :FR :3A S J..: JOB w: ITR DMS 03/25/2011 09:00 01:0 I X I IM 317 571 -2548 0.00 a TtipENm:'::5, 6P.HONE JASON POLICY<NUM8K12° cuwcmn :r :E.CS:. ll: :fl.: :•Nj7idHEk.:. Is UEHTCIE..IDit�tfEtEE[t;,..;:.. CB'iSE'UNTT. NUMBE& MII�EAGE:< SZ+TiES�'ER &OD7 TAKEN 2G1WS551469379840 /35 JAMES C LIPTON BSCHRIER i;i 2006 CHEVROLET IMPALA 4 DOOR SEDAN FORM::OE:. PAYEIIT. R f OPEN CHARGE INSURANCE COMPANY s QTY 3 PART:r NUMBER /DE SCRTP.lION LIST PRICE YJNIT.PRICH TOTAL 1 DWO164OGBYN Windshield (W /Third Visor Frit) 177 198.57 2 HAH000004 Urethane, Dam, Primer 0.00 0.00 SUBTOTAL 198.57 *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 'Safest Installation Alway TOTAL 198.57 INDIANA RETAIL TAX EXEMPT PAGE Cft C CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT MIX) 35- 60000972 ONE 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 "URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 919 I Gu&FdI@fl Gies Company Camof Police Dopadmont VENDOR SHIP 3 Civic Squam 24M NahmorU Flaw TO C armel, IN Chicago, JL W$73-1243 (317) 57i CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account -610.0 1 Each repairwirldshield $99$.55 Sub Total: $998.50 P> i 1_3 J ropirz to windshield for cor 351 Mothiaws 1 Send Invoice To: Carmel Police Dep otment Attn: Teresa Anderson 3 Civic squa m Camel, IN 2= PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Cartel P olice epy r,� l PAYMENT q 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 TI;AFTHERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. AP THIS PROPRIA IQ UFFICIENT TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED $Y PURCHASE ORDER NUMBER MUST APPEAR ON ALL J SHIPPING LABELS. lof of police THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO. 2 7 7 6 0 A.P.V. COPY SIGN AND RETURN TO CLERK OFFICE VOUCHER NO. WARRANT NO. ALLOWED 2© IN THE SUM OF S -i ON ACCOUNT OF APPROPRIATION FOR Board Members PO#f 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Guardian Glass Company IN SUM OF 24394 Network Place Chicago, IL 60673 -1243 $19 8.57 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# Dept INVOICE NO. ACCT /TITLE AMOUNT Board Members 27760 5205062630 43- 510.00 $198.57 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 Monday, April 11, 2011 Chief of Police 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 04/27/11 5205062630 payment for windshield repair $198.57 1 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