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Home My WebLink About197645 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