210869 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
0 ONE CIVIC SQUARE GUARDIAN AUTO GLASS,LLC
CARMEL, INDIANA 46032 24394 NETWORK PLACE CHECK AMOUNT: $222.80
CHICAGO IL 60673-1243 CHECK NUMBER: 210869
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 I520003496 222 . 80 AUTO REPAIR & MAINTEN
GUARDIAN AUTO GLASS LLC Copy 1
940 N SAADELAND AVE
INDIANAPOLIS, IN 46219-4810
PH:(800) 882-2244 FAX:(317) 353-6230 Federal Tax ID: 27-3440978
P/O#: Cust State Tax ID: 356000972 Workorder: W520003496
Taken By: BridgetSchrier Cust Fed Tax ID: 356000972
Installer: Ship Via: Date: 71212012
Time: 12:02 PM
S_ alesRep: HOUSE ACCOUNT Adv. Code:
Bill To: CARMEL P0121805-2520 Sold To: CARMEL P0121805-2520
CARMEL POLICE DEPT CARMEL POLICE DEPT
3 CIVIC SQ 3 CIVIC SQ
CARMEL, IN 46032 CARMEL, IN 46032
a x`
i..
(317) 571-2548 Fax: (317) 571-2507
Vehicle Information --- �--- — ---- ---
ur.
r Make: Chevrolet Model Style: Impala 4 Door Sedan Year: 2012
Odometer: VIN: License:
Fleet Number: Unit Number: 145 Color.
Qty Part Number Description List Sell Total
1 DWO164OGBYNCOM Windshield-(W/Third Visor Frit,Solar $247.25 $197.80 $197.80
Controlled)
1 HAH000004 Adhesive-(2.0,Urethane,Dam,Primer) $25.00 $25.00 $25.00
AuthBy: JASON
'No Warranty on Glass Removed and Reinstalled.
No warranty on customer supplied parts
vin_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Required Date 07/02/12, Mobile Install
Instructions: GOING TO 3 CIVIC SQ 46032
Sub Total: $222.80
Tax: $0.00
Customer's Signature: Net30 Total: $222.80
City ® /t° Carmel INDIANA RETAIL TAX EXEMPT PAGE
�J�l"" CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 202
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
e0 MMg2 _F
Caummliann Alga Chaos LLC C @fool Police Department
VENDOR
SHIP 3 Civic Squ
N. Shaldoland Avo TO Camel, IN
Indlaana';polln, IN 462194890 (3$7)671 2M
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account -690.00
9 Each repair windshield $222.80 $222.80
Sub Total: $222.80
anti 9'.. .v
L z
Send Invoice To:
Ca mol Polio Dopadment
Attn: Torona Andemon
3 Civic squam
Carmol, IN 46 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT F AMOUNT
Carmel Police Dept. L`xj PAYMENT _ 2.80
�`• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPR SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. ///Ehltof of Poiico
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL No- 26209 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO._---__._.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or T
INVOICE NO. ACCT#/ ITLE 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...-----.-....------
...
--.....................--.................
Signature
..................................._.....---.........---.......----- ---------...................--..................................................... Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund j
VOUCHER NO. WARRANT NO.
ALLOWED 20
Guardian Auto Glass LLC
IN SUM OF $
940 N. Shadeland Ave
Indianapolis, IN 46219-4810
$222.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1110 I 1520003496 I 43-510.00 I $222.80 1 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
Thursday, July 12, 2012
Chief of Police
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07/03/12 1520003496 windshield replacement $222.80
1 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