HomeMy WebLinkAbout233012 05/28/14 Coq
CITY OF CARMEL, INDIANA VENDOR: 361470
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******778.74*
CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 233012
9M�TON-�•"p` MEDINA OH 44256 CHECK DATE: 05/28/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 31971 227925 778.74 CARSEATS
-� MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000227925
REMITTANCE ADDRESS: Invoice Date: 5/8/2014
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 6/7/2014
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000125725
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAK RIDGE ROAD
CARMEL,IN 46032-2584 USA Carmel,IN 46032 USA
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31971 UPS ORIGIN Net 30 Days
IC068FSM ON BOARD35 INFANT CAR SEAT WBASE j 2 $ 77.4000 i $ 154.80
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 4 $ 47.2000 $ 188.80
3702098 TITAN 5 CARSEAT 50#2PK 2 j $ 57.7500 1 $ 115.50
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 4 ! $ 26.9500 $ 107.80
Booster Car Seat,Factory Select 2 pack
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER i 4 $ 14.9000 1 59.60
PACK)
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Tracking Numbers: 1 ZA7T6670390260851, 1 ZA7T6670390472024, 1 ZA7T6670390716805, 1 ZA7T6670391038448, 1 ZA7T66
Subtotal 626.50
Freight 152.24
Sales Tax 0.00
w. Discount 0.00
�LE�1 � j � ;C�QQR� aTJ�1 �+ Payment/CreditAmount 0.00
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771.74�
INDIANA RETAIL TAX EXEMPT PAGE
City ®f Carmel CERTIFICATE NO.003120155 002 0PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 31971
F 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
5i6IM14
Child Snume Carmel Police Depattment
R
VENDO@m Ro.." Ve Dl�tt�hurting, Inc. SHIP 3 Chic square
3,35 Lake Pik TO CarTnel, IN 4W32
Mcsdhia, Oil 442-.%
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-A-M.05
1 Each shipping charges $152.24 $152.24
2 Each On Board35 Infant Car Seat IC068FSM $77.40 $154.$0
4 Each High Back Booster Front Adj 93-L00E-1�1 $47.20 $188.80
2 Each Thar, 5 Carseat $57.75 $115.50
4 Each Chase No Harness Booster �4311��� $26.95 $107.60
l{ , 93�2 ��' '. � �-�
4 Each BaL'I41k!5S S�6IeI6tIea9 Booster �; � '.;t 99FS�M .�.;
$14.90 $59.60
Suer Total: $7781.74
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Send Invoice To: z ✓ r p � }
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Carmel Police Department __
Attn: Pat Young
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Caffrlel Police Dept. PAYMENT $770.74
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
-, __THIS APPROPRIATION SUFFICIENT, TO PAY FOR THE ABOVE ORDER.
•
• C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•
ORDERED BY'
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Chief��Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE t�s '1
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 31 9 71 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
$ I
I
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
i
.20
_ Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF $
Western Reserve Distributing, Inc.
305 Lake Rd
Medina, OH 44256
$778.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
I hereby certify that the attached invoice(s), or
31971 0000227925 -590.05 $778.74
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
Tuesd y, May 20, 2014
CZ/ 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))
05/08/14 0000227925 Car Seats $778.74
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