157078 03/05/2008 VENDOR: 00350559 P8
CITY OF CARMEL, INDIANA e 1 of 1 9
ONE CIVIC SQUARE GUARDIAN AUTO GLASS CHECK AMOUNT: $400.78
CARMEL, INDIANA 46032 12232 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 157078
CHECK DATE: 3/5/2008
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 17355 5205048516 400.78 REAR WINDOW REPAIRS
A UARD AUTO GLAS
GUARDIAN 940 N SHADELAND AVE
i ACompany of Vision INDIANAPOLIS, IN 4 6219
(317)353 -6178 (800)882 -2244
REMIT TO:
Guardian Auto Glass
INVOICE
WORK PERFORMED FOR: 12232 Collections Center Dr.
CARMEL POLICE DEPT Chicago, Illinois 60693
3 CIVIC SQ
CARMEL, IN 46032 5205048516
CARMEL POLICE DEPT
3 CIVIC SQ 02/18/2008
CARMEL, IN 46032 CLAIMANT
34- 0801385
520006879E
ACCOUNT: 121805 HP WP 02/13/2008
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DMS 02/15/2008 08:00 -05:0 X M- HAMILTON
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ROBERT
POLICI* »NUMB$Tk
PO# 173.55
tiIEHICLT ID >�f ItST3$i2 ;;z;;. T CE TSEIUNIT 'T?UM$E i MITtEAGE S ;:SPiIiEB PRSaiT t IGEAt BY:
2G1WF55K459364833 HOUSE 20 JWILLIAM
YEA& TSAT{E M4AETa '.:.:EOb4 Sti'Y#,$
2005 CHEVROLET IMPALA 4 DOOR SEDAN
f::FORbF.OF:!.EAYME3TT.> REFERRED:;:BY
OPEN CHARGE REPEAT CUSTOMER
QTY PART:.. 'NUMBER /DESCRIPTION LIST PRICE ::UNIT PRICE TOTAL
1 DB09626GTYN Back Window (Heated)(W /Antenna)(Sol 331.75
1 10446583 Moulding (Reveal) 69.03
SUBTOTAL .400.78
*STATEMENT OF AUTHORIZATION AND SATISFACTION SALES TAX �0.00-
REPLACEMENT HAS BEEN MADE TO MY SATISFACTION AND I HEREBY AUTHORIZE THE ABOVE
INSURANCE COMPANY TO PAY DIRECT IN FULL TO GUARDIAN AUTO GLASS FOR SAID INSTALLATION. DEDUCTIBLE
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.
DATE CUSTOMER /WITNESS
TOTAL 400.78
Your Satisfaction is Our Guarantee
INDIANA RETAIL TAX EXEMPT PAGE
City.
mel CERTIFICATE NO. 003120155 002 0 1 of 1
�v PURCHASE ORDER NUMBER
Po lice Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 17355
3 CIVIC SQUARE T NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46O3Z-2584 CHER, DELIVERY MEMO, PACKING SLIPS,
PPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
February 13. 2008 rear window repairs
VENDOR Guardian Auto Glass SHIP City of Carmel POlice Department
940 N. Shadilland Avenue TO 3 Civic Square
Indianapolis, IN 46219 Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
repairs to rear window for car 80 W. Collins
-331 S
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Of
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 510 auto repairs and maint PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
f NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I 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.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY Pt'��!_t
SHIPPING LABELS. Chief 6 Police f
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO.1 1 355
A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.� WARRANT NO.:__
ALLOWED 20
IN THE SUM OF
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
l which charge is made were ordered and
received except
20
Signature
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
Guardian Auto Glas Purchase Order No. 17355F
940 N. Shadeland Avenue Terms
Indianapolis, IN 46219 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2/18/08 5205048516 payment for rear window repairs 400.78
Total
I 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
Quardian Guto Glass
0 IN SUM OF
940 N. Shadeland Avenue
Indianapolis, IN 46219
400-79
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
5205048516 510 g 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
EebrrnarV 21 20 0,9
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund