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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 F 3 CIVIC SQ 1N57tifiCE.IJUfYiSEiZ CARMEL POLICE DEPT CARMEL, IN 46032 5205063028 INVOICE bA' ill 3 CIVIC SQ 04/28/2011 CARMEL, IN 46032 CLAIMANT 27- 3440978 zits 520008919 ORT1�Tt vATE':... ACCOUNT: 121805 HP: WP: 04/26/2011 INST _R�t" P1tOPOSEI3 ;�OMPLE:T�f3N. rJf['�E $R Ni4 .::TU WE.z 'A'Ti .0 TS WkxT. SU, ,;5 TWC 04/27/2011 09:00 01:0 X IM kTOME.?FXONE:`.> :EST h�T >t3 ;#(YSS. C2�t28 OF :Ii#SflS. I1EI7t7CTr$I,Ez::. 317 571 -2548 u5rttixHV AGRNT ^s::PHVNE JASON :':HbLICY:::i�ItTtiBEiks.. C� sl':P.<1.. NEdl16ER. .l`: 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 Vf' •a t� I i replado wlndiihi d ffdrr 3l og aa� 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