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168488 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1 ONE CIVIC SQUARE GUARDIAN AUTO GLASS 12232 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $370.00 CARMEL, INDIANA 46032 by oN i o CHICAGO IL 60693 CHECK NUMBER: 168488 J CHECK DATE: 2/412009 DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION 1110 4351000 19022 5205052458 370.00 REAR. WINDOW REPLACEME I GUARDIAN AUTO GLASS C;UARUI 94 0 N SHADELAND AVE A Company of Vision INDIANAPOLIS, IN 46219 (317)353-6178 (800)882-2244 REMIT TO: Guardian Glass company INVOICE WORK PERFORMED FOR: 24394 Network Place CARMEL POLICE DEPT Chicago, IL 60673-1243 3 CIVIC SQ CARMEL POLICE DEPT CARMEL, IN 46032 5205052458 3 CIVIC SQ 01/13/2009 CARMEL, IN 46032 CLAIMANT: 34-0801385 5200074347 ACCOUNT: 121805 HP: WP-. 01/08/2009 X[.: .101z M, :7 q: EDB 101/12/2009 08:00-0E ::WORK:..:P HONE; t §S t 317-571-2548 ox :;AGENT�6'::3':: >PHONE:: .:���:::��:::�:���:]:�:i:]: JASON ��iWQE xxi�:Ownpv im:mtt"E4 2G1WF55K459367859 ]JAMES C LIPTON BSCHRIER X X TEAR 2005 CHEVROLET IMPALA 4 DOOR SEDAN a OPEN CHARGE REPEAT CUSTOMER 1: a QTY UNIT::: PRICE TOTAL �:.:..:'::::::PART::�.:NUMBER/litS(�k±PTION LIST PRICE 1 DBO9626GTYN Back window (Heated)(W/Antenna) 022 238.26 1 LABOR 40.00 2 HM000004 Urethane, Dam, Primer 5.00 10.00 1 10446583 Moulding (Reveal) 81.74 SUBTOTAL 370-00 ****STATEMENT OF AUTHORIZATION AND SATISFACTION**** SALES TAX 0.00 REPLACEMENT RAS 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 370.00 Your satisfaction is our Guarantee Ci ty /f� INDIANA RETAIL TAX EXEMPT PAGE 1 CERTIFICATE NO. 003120155 002 0 f 1 PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 1 4 7 CAR ©uN CIVIC SQUARE FHISN BER MUST APPEAR ON INVOICES, A/P MEL, INDIANA 46032 -2584 DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION Jnnij 7009 1 rear window replacement VENDOR Guardian Auto Glass q SHIP City of Carmel Police Department 940 Shadeland Avenue TO 3 Civic Square Indianaplis, IN 46219 Carmel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION replace rear window for aer 56 R. Harris 356.38 (J z o o o� Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1110 510 auto f Q and maintenance 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 SHIP REPAID. THIS APP OPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. 1 C.O.D. SHIPMENTS CANNOT BE ACCEPTED. 1 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. CLERK TREASURER DOCUMENT CONTROL NO 9 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 which charge is made were ordered and received except 20 Signature r 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. 19022F 940 N. Shadeland Avenue Terms Indianapolis, IN 46219 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1/13/09 5205052458 payment for rear window replacement 370.00 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. I ALLOWED 20 Guardian Auto Class IN SUM OF 940 N. Shadeland Avenue Indianapolis, IN 46219 370.00 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 19022F 5205052458 510 370.00 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 January 30 20 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund