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Home My WebLink About178699 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 ONE CIVIC SQUARE GUARDIAN AUTO GLASS CHECK AMOUNT: $275.24 CARMEL, INDIANA 46032 24394 NETWORK PLACE CHICAGO IL 60673 -1243 CHECK NUMBER: 178699 CHECK DATE: 10/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 5205055971 75.00 AUTO REPAIR MAINTEN 1110 4351000 21225 5205055987 200.24 WINDSHIELD REPLACEMEN GUARDIAN AUTO GLASS GUARDIAN 940 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 (317)353-6178 (800)882-2244 MVR# Y REMIT TO: Gu ardian Glass Company INVOICE WORK PERFORMED FOR: 2 Network Place CARMEL POLICE DEPT Chicago, IL 60673-1243 3 CIVIC S Q N HE k CARMEL, IN 46032 5205055971 CARMEL POLICE DEPT mq: L 3 CIVIC SQ 10/08/2009 CARMEL, IN 46032 CLAIMANT: 34-0801385 520 0-079478 ACCOUNT: 121805 HP WP 10/07/2009 ms 1: WE 1 T JW 110/08/2009 08:00-05:0 x M-HAMILTON 317-571-25481 JASON j injo iO ..:TAXRN: $?.FF SON, 2G1WF55K439309649 /20 JAMES C LIPTON BSCHRIER M 2003 CHEV IMPALA �4dRk�lbc: 4 OPEN CHARGE REPEAT CUSTOMER L I J b E TOTAL LIST. PRICE .::�JTNIT:x PRICE:]:: QT 1 REMOVE REINSTALL REMOVE ONLY W/S 37.50 1 REMOVE REINSTALL REMOVE ONLY B/G 37.50 SUBTOTAL 75:..00 ****STATEMENT OF AUTHORIZATION AND SATISFACTION**** REPLACEMENT HAS BEEN MADE TO K Y 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 LEAKAGE WHEN CHECKED; DATE CUSTOMER /WITNESS "Safest Installation A 75.00 lways" TOTAL GUARDIAN AUTO GLASS C;UAltDIAN 940 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 (317)353-6178 (800)882-2244 MVR# Y REMIT TO: Guardian Glass Company INVOICE WORK PERFORMED FOR: 24394 Network Place CARMEL POLICE DEPT Chicago, IL 60673-1243 3 CIVIC SQ CARMEL, IN 46032 s. 5205055987 CARMEL POLICE DEPT 3 CIVIC SQ 10/08/2009 CARMEL, IN 46032 CLAIMANT: 34-0801385 5200079458 ACCOUNT: 121805 HP: WP- 10/07/2009 JW 10/07/2009 08:00-05:0 X I-MARION F7 i 317-571-254 M AUTHfkRZiEiS :BY;:: NA JASON :�:i 'MIX 2G1WE55K639316358 IJAMES C LIPTON IBSCHRIER 2003 CHE VROLET IMPALA 4 DOOR SEDAN OPEN CHARGE REPEAT CUSTOMER QTY R LIST:: UNIT PRICE; TOTAL PA X 7 :r I DWO155OGBYN Windshield (W/Third Visor Frit) 904 185.24 2 HAK000004 Urethane, Dam, Primer 7.50 15.00 SUBTOTAL 200.24 ****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 SURFACE RUST OR CORROSION PRESENT AND TREATED NO WARRANTY AGAINST LEAKAGE WHEN CHECKED: DATE CUSTOMERIWITNESS_ TOTAL 200.24 "Saftest Installation Always" JL INDIANA RETAIL TAX EXEMPT PAGE Cli ®II C a ei rmCERTIFICATE NO. 003120155 002 0 \1rli PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 21225 35- 60000972 3pN ff 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 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Octeber 200 windshield replacement VENDOR Guardian Auto Glass SHIP City of Carmel Police Department 940 N. Shadeland 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 replace windshield for car 108 Case 200.24 U Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1110 510 auto repairs and mains a nceP AYMENT 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. CA.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 Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. WARRANT NO.�___ ALLOWED 20 i 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 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 Glass Purchase Order No. 21225F 940 N. Shadeland Avenue Terms Indianapolis, IN 46219 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 10/8/09 5205055971 payment for windshield removals for range vehicle 75.00 10/8/09 5205055987 payment for windshield replacement for car 63 1 Case 200.24 Total 275.24A 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 275.24 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 1110 5205055971 510 75.00 bill(s) is (are) true and correct and that the 21225F 5205055987 510 200.24 materials or services itemized thereon for which charge is made were ordered and received except October 19 20 09 Signature Assistant Chief of poli Title Cost distribution ledger classification if claim paid motor vehicle highway fund