168007 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
s ONE CIVIC SQUARE GUARDIAN AUTO GLASS CHECK AMOUNT: $181.32
CARMEL, INDIANA 46032 12232 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693 CHECK NUMBER: 168007
CHECK DATE: 1/21/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 19017 5205052352 181.32 WINDSHIELD REPLACEMEN
G 44 UA RDlA N AUTO GLASS
GUARDIAN 9 4 0 N SHADELAND A VE
A Compa- of Vision INDIANAPOLIS, IN 4 6219
(317)353-6178 (800)882-2244
REMIT TO:
Guardian Class Company
INVOICE WORK PERFORMED FOR: 24394 Network Place
CARMEL POLICE DEPT Chicago, IL 60673-1243
3 CIVIC SQ I.. I I
F Nvolcg;
440
CARMEL, IN 46032 5205052352
CARMEL POLICE DEPT
3 CIVIC SQ 01/06/2009
CARMEL, IN 46032 CLAIMANT:
34-0801385
5200074139
..;::ORDER
ACCOUNT: 121805 Hp- WP: 12/29/2008
tt! bg.::
DMS 112/31/2008 08:00 x j I
CAU
317-571-25481
ROBERT
JPO# 19017
v
2G1WF55K259370209 IHOUSE 20 IBSCHRIER
2005 CHEVROLET IMPALA 4 DOOR SEDAN
OPEN CHARGE REPEAT CUSTOMER
PART NUMBE "UNIT.PRIC TOTAL
1 DWO15SOGBYN windshield (W/Third Visor Frit) 022 181.32
2 HAH000004 Urethane, Dam, Primer 0.00 0.00
SUBTOTAL.
****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 181.32
Your Satisfaction is our Guarantee
INDIANA RETAIL TAX EXEMPT PAGE
O t ®_f C a rmel CERTIFICATE NO. 0031 201 55 002 0 I of 1
111 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT 19017
35- 60000972
3 GRECIVIC 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
Tanua v 8 2Q windshield replacement
VENDOR Guardian Auto Glass SHIP City of Carmel Police Department
940 N. Shadeland Avenuye TO 3 Civic Square
Indianapoiis, IN 46219 Carmel, IN 46032
CONFIRMATION BLANKET C ONTRACT PAYM TERMS FREI
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
replace windshield for car 45 K. White 181.32
a
f
-�6 r�°IX 3 4 4 �t
Send Invoice To:�
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT j PROJECT PROJECT ACCOUNT AMOUNT
1110 510 auto repairs and mainte n. a 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 APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
j1 'mil
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY &1 r�'G'.,('
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
-L J u 7 CLERK TREASURER
DOCUMENT CONTROL NO A. .V. COPY SIGN AND RETURN TO CLERIC'S OFFICE
UCHER 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. T
26
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. 19017F
940 N. Shadeland Avenue Terms
Indianapoils, IN 46219 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/6/09 5205052352 pyament for windshield replacement 181.32
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.
r•
ALLOWED 20
G uardian Auto Glass IN SUM OF
940 Nf Shadeland Avenue
I dianapolis, IN 46219
181.32
ON ACCOUNT OF APPROPRIATION FOR
police g eneral fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
19017F 5205052352 510 181.32 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 15 20 09
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund