155739 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
ONE CIVIC SQUARE GUARDIAN AUTO GLASS
CARMEL, INDIANA 46032 12232 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $381.93
CHICAGO IL 60693 CHECK NUMBER: 155739
CHECK DATE: 1/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 17317 5205047948 381.93 WINDOW REPLACEMENT
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GUA RDIAN A UTO G
GUARDIAN 940 N SHADELAND AVE
A Company of Vision INDIANAPOLIS, IN 46219
(317)353 -6178 (800)882 -2244
REMIT TO:
INVOICE Guardian Auto Glass
WORK PERFORMED FOR 12232 Collections Center Dr.
CARMEL POLICE DEPT Chicago, Illinois 60693
3 CIVIC S4
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CARMEL, IN 46032 5205047948
CARMEL POLICE DEPT
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3 CIVIC SQ 01/07/2008
CARMEL, IN 46032 CLAIMANT
FKDERIiT�: TAX: ::NUMBER«::
34- 0801385
5200068020
ACCOUNT: 121805 HP WP 01/03/2008
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DMS 01/04/2007 08:00 12:0 X M HAMILTON
LOSS:.:
317 571 -2548
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ROBERT
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PO# 17317
2G1WF55K449417562 IHOUSE 20 BSCHRIER
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2004 CHEVROLET IMPALA 4 DOOR SEDAN
?4••�3F •PI'KME
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OPEN CHARGE YELLOW PAGES
QTY PART: :NUMBER /DESCRIPTION LIST PRICE UNIT PRICE TOTAL
1 DB09626GTYN Back Window (Heated)(W /Antenna)(Sol 331.93
1 LABOR 40.00
2 HAH000004 Urethane, Dam, Primer 5.00 10.00
SUBTOTAL 381.93
*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.
IF FOR ANY REASON THE INSURANCE COMPANY DOES NOT PAY FOR THESE REPAIRS OR DEDUCTIBLE
REPLACEMENTS THE BELOW SIGNED AGREES TO PAY FOR SAID REPAIRS OR REPLACEMENTS.
DATE CUSTOMER /WITNESS
TOTAL 381.93
Your Satisfaction is Our Guarantee
INDIANA RETAIL TAX EXEMPT PAGE C o II Carmel PURCHASE OR CERTIFICATE NO. 003120155 002 0 D Jl DER NUMBER
i
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 1 317
3 e...,
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA UARE25H4 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING 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
January 4, 2009 window replacement
VENDOR Guardian Auto GUss SHIP City of Carmel. Police Department
940 N. Shadeland Avenue TO 3 Civic Square
Indianapolis, IN 46119 Carmel, IN 46032
CONFIRMATION BLANKET I CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
rear window replacement for car. 27 Sedbarry 361.93
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4
0
3
eve
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Send Invoice To:�'� 1
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 510 auto repairs and matntanance PAYMENT
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
THIS APPROPRIATION SU TO THE ABOVE ORDER.
SHIP REPAID. OPRIA
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE AssUtatt Chie -of POli.ce
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO .1 7 3 1 7A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO..
ALLOWED 20
IN THE SUM OF J
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
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 Glass Purchase Order No. 17317F
940 N. Shadeland Avenue Terms
Indianapolis, IN 46219 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/7/08 5205047948 payment for rear windshield replacement 381.
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
Guardian Auto Glass IN SUM OF
940 N. Shadeland Avenue
Indianapolis, IN 46219
381.93
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
5 205047948 510 381.93 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
In nuar3V? 4 20 nR
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund