HomeMy WebLinkAbout199483 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC CHECK AMOUNT: $190.60
CARMEL, INDIANA 46032 24394 NETWORK PLACE
CHICAGO IL 60673 -1243 CHECK NUMBER: 199483
CHECK DATE: 7120/2011
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 25790 5205063844 190.60 REPAIR WINDSHIELD
r GUARDIAN AUTO GLASS LLC
GUARDIAN 94 0 N SHADELAND AVE
A Company of Vision INDIANAPOLIS, IN 46219
REMIT TO:
(317)353 (800)882-2244 Guardian Auto Glass LLC
MVR# Y 24394 Network Place
Chicago, IL 60673 -1243
INVOICE WORK PERFORMED FOR
PAYMExT. p,11E
CARMEL POLICE DEPT 07/30/2011
3 CIVIC SQ 1�t S70:IC3z NUMBER
CARMEL POLICE DEPT CARMEL, IN 46032 5205063844
�NOICE,DATE
3 CIVIC SQ 06/30/2011
CARMEL, IN 46032 CLAIMANT
FEDERAL TAX #NUMBER
27- 3440978
5200090208
ORDER i)AT`E
13CGOU *IT: 121805 HP: WP, 06/29./2011
Y PROI?OSED.- .tOMPDET:i)Z� :Ydtt.E.....,',7? t0 ID ATE::: h�AI`�..:
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DMS 06/30/2011 08:00 -05:0 X M- HAMILTON
fTDME;:Pi 02 E. W(7R3� :P i[?3Ifi :EBT DATE :03a' L(}SS. :CAUSE.1100 "LOSS 1aE t1Cfi�.B i
317 -571 -2548
A#3TH(3RTZED J3Y s .ROE 7T S' :NAME ;:?tGEN.T'.'::3 PHON}:
JASON
POLTCg<?'Ni3MBER
VEi#YCT'i;. 131 3Nt?°MB13R :i�IGBNSE:' >UN#�''i:1�fl3.�SSER <bFISiEACE's <SPi�;EB�?S€tS.Ot# TAItEN BY :;i',
2G1WS55R279342860 ./8 JAMES C LIPTON JWILLIAM
Y6A> 3YIAT�E: K)Q$D a EODY .:ST.......
2007 CHEVROLET IMPALA 4 DOOR SEDAN
:1 s :32EEE "8Y
OPEN CHARGE REPEAT CUSTOMER
QTY PART /DESCRIPTION LIST .PRICE: ,UNIT PRICE TOTAL
1 DWO164OGTYN Windshield (W /Third Visor Frit) 177 190.60
2 RAH000004 Urethane, Dam, Primer 0.00 0.00
I
SUBTOTAL 190.60
*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
SUR FA C E RUS O R CO P A ND TR EATED N W ARRANTY A LEAKAGE WHEN CHECKED.
DATE CUSTOMER /WITNESS
"Safest Installatio Always" TOTAL
190.60
INDIANA RETAIL TAX EXEMPT PAGE
C f C are l m CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
r FEDERAL EXCISE TAX EXEMPT 26M
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 O RDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
TM20il
GuamIan GIaas Compww Cumol Police Depadment
VENDOR
SHIP 3 Civi Squaam
4 Network Piaw TO Carmol, IN d
Chicago, IL IM =9 (317) 571
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
GUANTfTY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43- 690.01
1 Each repirwindshield $990.60 $100.00
Sub Total: $190.60
d
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6w
Send Invoice To:
Camal Police Dopawtmont
Attar Teresa Andervon
3 Civic squam
Caul, IN a PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT j PROJECT ACCOUNT AMOUNT
Caamel Police Dept. PAYMENT $9811.60
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.
T IS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ?G�
PURCHASE ORDER NUMBER MUST APPEAR ON ALL Q 8
SHIPPING LABELS. Chief o Polka
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO,
DOCUMENT CONTROL NO. 2 5 7 90
CLERK SIG A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF S
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. l 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
Tale
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))
06/30/11 5205063844 payment for windshield repairs $190.60
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Guardian Glass Company
IN SUM OF
24394 Network Place
Chicago, IL 60673 -1243
$190.60
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
25790 I 5205063844 I 43- 510.00 I $190.60 1 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, July 14, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund