HomeMy WebLinkAbout197204 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC
CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $210.88
CHICAGO IL 60673 -1243
CHECK NUMBER: 197204
CHECK DATE: 5/11/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 27793 5205063028 210.88 WINDSHIELD REPAIR
GUARDIAN AUTO GLASS LLC
CRI.4RDIAN 940 N SHADELAND AVE
ACompany of Vision INDIANAPOLIS, IN 46219
REMIT TO:
(317)353-6178 (800)882-2244 Guardian Auto Glass LLC
24394 Network Place
R# Y Chicago, IL 60673 -1243
INVOICE WORK PERFORMED FOR: ph�iwl Dvr Q
CARMEL POLICE DEPT 05128/2011
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CARMEL POLICE DEPT CARMEL, IN 46032 5205063028
INVOICE bA'
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3 CIVIC SQ 04/28/2011
CARMEL, IN 46032 CLAIMANT
27- 3440978
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520008919
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ACCOUNT: 121805 HP: WP: 04/26/2011
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2G1WS55R479341032 /30 JAMES C LIPTON BSCHRIER
2007 CHEVROLET IMPALA 4 DOOR SEDAN
OPEN CHARGE REPEAT CUSTOMER
QTY PART(::NUMBElt /DESCRIPTION LIST PRICE UNIT,P TU AL
1 DWO164OGBYN Windshield (W /Third Visor Frit) 904 195.88
2 HAH000004 Urethane, Dam, Primer 7.50 15.00
SUBTOTAL 210.68
*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 PRESE AND TREATED N O WARRANT AG AIN S T LEAKAG WHEN C
DATE CUSTOMER /WITNESS
"Safest Installation Always" TOTAL
210.86
.c o INDIANA RETAIL TAX EXEMPT PAGE S
ity ®f arm( CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 277
35- 60000972
ONE 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.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
4691
Gu @Mi2n GI220 company Cumal Police Mpartmen$
VENDOR SHIP 3 CIVIC sgum
24M NGt=rh PlaCG TO C @rmol, IN 462
Chicago, IL MM-1249 (397) 671
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
,account 43 -90M
9 Each r win dshield $290.88 MOM
Sub Total: $290.88
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Send Invoice To:
Camel Police Department
Attn: YGraza Antheraon
3 CIVI sgum
Camel, IN 4e2= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT
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 APPROPRIATI i fl FICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. 7.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. 1 0 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-27793 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
C/}
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Guardian Glass Company
IN SUM OF
24394 Network Place
Chicago, IL 60673 -1243
$210.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# I Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members
27793 5205053028 43- 510.00 $210.88
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
Thursday, M 2 y 05, 2011
ev
Chie o P o li ce
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))
04/28/11 5205063028 payment for windshield replacement $210.88
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