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Home My WebLink About199483 07/20/2011 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC CHECK AMOUNT: $190.60 CARMEL, INDIANA 46032 24394 NETWORK PLACE CHICAGO IL 60673 -1243 CHECK NUMBER: 199483 CHECK DATE: 7120/2011 DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 25790 5205063844 190.60 REPAIR WINDSHIELD r GUARDIAN AUTO GLASS LLC GUARDIAN 94 0 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 REMIT TO: (317)353 (800)882-2244 Guardian Auto Glass LLC MVR# Y 24394 Network Place Chicago, IL 60673 -1243 INVOICE WORK PERFORMED FOR PAYMExT. p,11E CARMEL POLICE DEPT 07/30/2011 3 CIVIC SQ 1�t S70:IC3z NUMBER CARMEL POLICE DEPT CARMEL, IN 46032 5205063844 �NOICE,DATE 3 CIVIC SQ 06/30/2011 CARMEL, IN 46032 CLAIMANT FEDERAL TAX #NUMBER 27- 3440978 5200090208 ORDER i)AT`E 13CGOU *IT: 121805 HP: WP, 06/29./2011 Y PROI?OSED.- .tOMPDET:i)Z� :Ydtt.E.....,',7? t0 ID ATE::: h�AI`�..: '<x�TST is DMS 06/30/2011 08:00 -05:0 X M- HAMILTON fTDME;:Pi 02 E. W(7R3� :P i[?3Ifi :EBT DATE :03a' L(}SS. :CAUSE.1100 "LOSS 1aE t1Cfi�.B i 317 -571 -2548 A#3TH(3RTZED J3Y s .ROE 7T S' :NAME ;:?tGEN.T'.'::3 PHON}: JASON POLTCg<?'Ni3MBER VEi#YCT'i;. 131 3Nt?°MB13R :i�IGBNSE:' >UN#�''i:1�fl3.�SSER <bFISiEACE's <SPi�;EB�?S€tS.Ot# TAItEN BY :;i', 2G1WS55R279342860 ./8 JAMES C LIPTON JWILLIAM Y6A> 3YIAT�E: K)Q$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 a`.A 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