HomeMy WebLinkAbout197645 05/26/2011 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC
i I CHECK AMOUNT: $205.60
CARMEL, INDIANA 46032 24394 NETWORK PLACE
CHICAGO IL 60673 -1243 CHECK NUMBER: 197645
CHECK DATE: 5/2612011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 27823 5205063212 205.60 REPAIR WINDSHIELD
[gn GUARDIAN A UTO GLASS LLC
GL1A1RDIA..N 94 0 N SHADELAND AVE
A Company of Vision INDIANAPOLIS, IN 46219
REMIT TO:
(317)353 (800)882-2244 Guardian Auto Glass, LLC
MVR# Y 24394 Network Place
Chicago, IL 60673 -1243
INVO WORK PERFORMED FOR: rsr nA
CARMEL POLICE DEPT 06/15/2011
3 CIVIC SQ INVOICE iJtJf 2lSEIi
CARMEL POLICE DEPT CARMEL, IN 46032 5205063212
r�fIMD�[CE E7AT�
3 CIVIC S4 05/16/2011
CARMEL, IN 46032 CLAIMANT:
.�'SDE$AL 1'R7T- :NUMBFsIt:
27- 3440978
5200089435
ACCOUNT: 121805 HP: WP: 05/13/2011
xNST ;S3C. p1tOPO8ED :L? 21T 3A`.
DMS 05/13/2011 08:00 -05:0 X M- HAMILTON
317- 571 -2548
AUT1i0'RT
A GENT
AGENT' S :PHbN£::
THOMPSON
PbLICY >:NUMgNi s,
W PO# 27823
:tr x tCLE IMAOM gag
2G1WS55106937'8474 JAMES C LIPTON JLIPTON
Y iP R Mm a
2006 CHEVROLET IMPALA 4 DOOR SEDAN
RkERRHD.<::EY.
OPEN CHARGE REPEAT CUSTOMER
PART]. NUMBER/DES CRIP. TION x LIST.PRICE UNIT PRICE: TOTAL
I DWO164OGTYN Windshield (W /Third Visor Frit) 177 190.60
1 RAH000004 Urethane, Dam, Primer 15.00
1
SUBTOTAL 205..`60
*9TATEMENT_OF, AUTHORIZATION _AND SATISFACTION
REPLACEMENT HAS SEEN 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 LE WHEN CHECKED:
DATE CUSTOMER /WITNESS
"Safest Installation Always" TOTAL
205.60
City Car INDIANA RETAIL TAX EXEMPT PAGE
1Jlr CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 278n
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
DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
3�9�02099
Gu2mNan Clegg Comps Carmel Police Department
VENDOR SHIP 3 CIVIC sQBdm
243M NQftmri� Place TO Cumel, IN 46032
Chicago, IL MM4243 (397) 379 -2
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
.0
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43 -690.03
9 Each repalir Andshield $203.80 $203.30
Sub Total: $203.60
1
0
R), -4e
zi
windshield replacement V1 923f Ho on
Send Invoice To:
Cool Police Dopmftrnont
Attn: Tomm Anderson
3 Civic aqum
CUB MG1, IN 4m- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Cumel PolIC® Gp$• PAYMENT wxu
v 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.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. i ®f 0 Y Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO-27823 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
$205.60
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept INVOICE NO. ACCT /TITLE AMOUNT Board Members
27823 5205063212 43- 510.00 $205.60 f 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, May 19, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City F=orm 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))
05/16/11 5205063212 payment for windshield repairs $205.60
E 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