HomeMy WebLinkAbout235565 08/06/14 •4�q
J`% ''4� CITY OF CARMEL, INDIANA VENDOR: 361470
,i ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******915.00*
?� CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 235565
�4jlroii�°'� MEDINA OH 44256 CHECK DATE: 08/06/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 32092 0000232417 915.00 BOOSTER CARSEAT
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000232417
REMITTANCE ADDRESS: Invoice Date: 7/22/2014
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE 8/21/2014
305 LAKE RD Invoice Due Date:
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000127879
Sold To Ship To
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL,IN 46032-2584 USA A GALLAGHER 317-571-2720
Carmel,IN 46032 USA
Cussstomer P O.-.
32092 UPS ORIGIN Net 30 Days
Item Description Qty Shipped Unit Price Amount y
IC086BXT Safety 1 st OnBoard 35 (Ross)(Weight range 4LB-35 4 $ 84.0000 $ 336.00
lbs)
3702098 TITAN 5 CARSEAT 504 2PK 4 $ 57.7500 $ 231.00
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 2 $ 26.9500 $ 53.90
Booster Car Seat,Factory Select 2 pack
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 2 $ 47.2000 $ 94.40
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER 4 $ 14.9000 $ 59.60
PACK)
--------------------------------------------------------------------------------- LAST ITEM ---------------------------------------------------------------------------------
Tracking Numbers: 1 ZA7T6670390300914, 1 ZA7T6670390585706, 1 ZA7T6670391275245, 1 ZA7T6670391812879, 1 ZA7T66
Subtotal 774.90
Freight 140.10
Sales Tax 0.00
Discount 0.00
PLEASE NOTE NEW REMITTANCE Pavment/CreditAmount 0.00
ADDRESS ABOVE Balance Due 915.00
INDIANA RETAIL TAX EXEMPT PAGE
City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT SM2
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.
,PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
71712014
Child Source Carmel Police Department
stare Reserve DIatributing, Inc. SHIP 3 Civic Squame
VENDOR
305 Lake Rd TO Carmel, IN 46032
Medina, OH 442% (317)571-25.59
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITYUNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-M-0.05
1 Each shipping charges $140.10 $140.10
4 Each Safety 1 st on board 4-351b IC086BXT $84.00 $336.00
4 Each Booldess Shleldiess Booster 43-204FSNI $14.00 $54.60
2 Each High Back Booster Front Adj f�43,200�w6 t $47.20 $934.40
2 Each Chase No Harness Booster 17, ' 13311 , !; $26.935 $53.40
4 Each Titan 5 Carseat $57.75 $231.00
.I. Sub Total: $915.00
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quote 127870
Send Invoice To:
Carmel Police Department .��..�
Attn: Pat Young
3 Civic squam
Carmel, IN dm PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. �� - W ID.�a
PAYMENT
i A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY 6
SHIPPING LABELS. i�i4yt of polle@
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 3 2 0 92 A.P.V. COPY-SIGN AND RETURN TO CLERIC'S OFFICE
VOUCHER NO, WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
SEPT.# 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
--_— __ --- Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
Child Source 'ALLOWED 20
Western Reserve Distributing, Inc.
IN SUM OF$ '
305 Lake Rd
Medina, OH 44256
$915.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#fTITLE AMOUNT Board Members
32092 0000232417 -590.05 $915.00 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, my 30, 2014
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
l
' I
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))
07/22/14 0000232417 Car Seats $915.00
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