215033 12/04/2012 CITY CIF CARMEL, INDIANA VENDOR: 00350559 Page 1 of 1
0 ONE CIVIC SQUARE GUARDIAN AUTO GLASS, LLC
CHECK AMOUNT: $288.28
CARMEL, INDIANA 46032 24394 NETWORK PLACE
CHICAGO IL 60673-1243 CHECK NUMBER: 215033
CHECK DATE: 12/4/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351000 25525 I520005229 288 . 28 WINDSHIELD REPAIR
'UARDIAN AUTO GLASS LLC Copy 1
90 N SHADELAND AVE
DIANAPOLIS, IN 46219-4810
WO# W520005229
Yo?
!E'H:(800) 882-2244 FAX(317) 353-6230 Federal Tax ID: 27-3440978
Remit To: 24394 Network Place, CHICAGO, IL 60673-1243
PLO#: Cust State Tax ID: 356000972 Invoice: 1520005229
Taken By: BridgetSchrier Cust Fed Tax ID: 356000972
Installer: TerryCarlisle Ship Via: Date: 11/16/2012
Time: 11:55 AM
SalesRep: Adv. Code:
t- Bill To: CARMEL P0121805-2520 Sold To: CARMEL P0121805-2520
CARMEL POLICE DEPT CARMEL POLICE DEPT
1�s
a 3 CIVIC SQ 3 CIVIC SQ
CARMEL, IN 46032 CARMEL, IN 46032
`n•F)3
W. (317) 571-2548 Fax: (317)_571-2507 _
`t -- Vehicie information
Make: Dodge Model Style: Grand Caravan Mini Van Year: 2012
Odometer: VIN: 2C4RDGLG7CR132048 License:
I" Fleet Number: Unit Number: 155 Color:
s,. _
C:.Qty Part Number Description List Sell Total
1 DWO1818GBNNCOM Windshield-(W/Third Visor Frit,Solar $329.10 $263.28 $26128
Controlled)
^,, PO# 5202938 C0001824.
{T 1 ..HAH000004 Adhesive-(2.5,Urethane,Dam,Primer) $25.00 $25.00 $25.00
17KA6thBy:''Ep...., ..
`; No Warranty on Glass Removed and Reinstalled. ,
ffNo warranty on customer supplied parts
;S�zq
-vin
— — — — — — — — — — — — — — — — —
i
Sub Total: $288.28
Tax: $0.00
C'ustomer's Signature: Net30 On Account: $288.28
w
LIMITED WARRANTY_
manufacturer's defect in the glass or any leaking or other defect related to the installation of stationary glass parts will be covered for as long as you
own the vehicle. Any manufacturer's defect in'the glass or a defect of workmanship or leaking related to the installation of moveable glass parts is covered
fory90' days from the date of installation. Any crack or run from the original point of a chip repair of your windshield as identified in the primary vision area
vvill be covered for as long as you own the vehicle. The amount you paid for the original chip repair of your windshield will be applied toward the replacement
cost of a new windshield purchased from and installed by Guardian Auto Glass. Refer to the Limited Warranty document for additional information.
Y,ou must present the Limited Warranty document to ensure warranty eligibility. The Limited Warranty applies to all Insurance and Cash
9pstomers. Direct any inquiries about Commercial warranties to the Manager.
6230
Guardian Auto Glass LLC 940 N Shadeiand Ave INDIANAPOLIS, IN 46219-4810 PH:(800) 882-2244 FAX:(317)353
INDIANA RETAIL TAX EXEMPT PAGE
City ® 11 Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT M
35-60000972
ONE 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
Guairdian Auto Glass LLC Camel Pollee Department
VENDOR SHIP 3 CIVIC squara
TO
940 N. Shadeland' Aye Carmel, IN 4603"_
' Indianapolis, IN 462194816 (W)579
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43-610.00
1 Each repair windshield $288.28 $288.28
Sub Total, $288.28
Vt N_
__\6
car 155 '- Y r
Send Invoice To:
Carmel Police DepaAment
Attn:Temsa Anderson
3 CIVIC Square
Carpel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Camel Police Dept, �� t PAYMENT $ 88.2 3
�.� 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 SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY -�1 t•,!'`
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL �r
SHIPPING LABELS. Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS isms TITLE (�hlof °41?I
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
;} A�5 CLERK-TREASURER
DOCUMENT CONTROL NO. A�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 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 k
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Guardian Auto Glass LLC
IN SUM OF $
940 N. Shadeland Ave
Indianapolis, IN 46219-4810
$288.28
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25525 I 1520005229 I 43-510.00 I $288.28 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
Wednesday, November 28, 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))
11/16/12 1520005229 window repairs/car 155 $288.28
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