241245 01/22/15 [qq .
CITY OF CARMEL, INDIANA VENDOR: 361470
i' ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******972.60*
CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 241 245
9M'UM gip.? MEDINA OH 44256 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 R4359005 32271 0000244344 972.60 CARSEATS
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Number: 0000244344
REMITTANCE ADDRESS:
Invoice Date: 1/8/2015
WESTERN RESERVE DISTRIBUTING. INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 2/7/2015
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000133605
Sold To Ship To
CARMEL POLICE DEPARTMENT. CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032-2584 USA Carmel, IN 46032 USA
– Customer-P–.O. — -Ship Via. _
32271 UPS ORIGIN Net 30 Days
Item Description Qty Shipped Unit Price Amount
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 4 $ 77.4000 $ 309.60
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 4 $ 47.2000 $ 188.80
3702098 TITAN 5 CARSEAT 50#2PK 4 $ 57.7500 $ 231.00
3431 198 Chase No Harness 40-110 lbs(18-49,8kg) 4 $ 26.9500 $ 107.80
Booster Car Seat, Factory Select 2 pack
------------------------------------------------------------------------------- LAST ITEM ------------------------------------
Tracking Numbers: 1 ZA7T6670390085890, 1 ZA7T6670391071410, 1 ZA7T6670391316209, 1 ZA7T6670391525840, 1 ZA7T66
Subtotal 837.20
Fre i P-ht 135.40
Sales Tax 0.00
Discount 0.00
PLEASE NOTE NEW REMITTANCE Payment/CreditAmount 0.00
ADDRESS ABOVE Balance Due 972.60
O ® (�° Carmel
INDIANA RETAIL TAX EXEMPT PAGE
City
,Jlr CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 32279
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
i2/02W
Child Source Cumel Pollco Department
VENDORMatorn Rosorvo Dlotributing, Inc. SHIP 3 Civic Squaw
I9aho Rd TO Cumol, IN 4
M@dina, ON 44228A (397)679.
CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00 .05
9 Each shipping $135.40 $135.40
4 Each Chase No Harness Rooster 3431198 $26.95 $1,07.80
4 Each Titan 5 Carseat 3702098 $57.75 $231.00
4 Each High Rack Rooster Front Adj $47.20 $188.80
4 Each On R®ard351nnt Car Seat ,,�- 1C68aq o $77.40 $309.50
Saab Tot@]: $972.60
4y
Q) Wrl
Send Invoice To: ��
�1
Carmel Police.Depadment
Attn: Pat Young
3 Civic Squm
Camel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
aafmol Police Dept. PAYMENT W2.60
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• J//•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL i
SHIPPING LABELS. C ®Q Pollc(a
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE I�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 32271 A.P.V. COPY-SIGN AND RETURN TO CLERIC'S OFFICE
VOUCHER NO.__.--_-_WARRANT NO.-
ALLOWED 20
IN THE SUM OF$
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#MTLE 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
+ � 20
Signature
t
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
li
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))
01/08/15 0000244344 car seats $972.60
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
i
VOUCHER NO. WARRANT NO. _ '
ALLOWED 20
Child Source
IN SUM OF $
Western Reserve Distributing, Inc.
305 Lake Rd
Medina, OH 44256
$972.60
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32271 I 0000244344 I -590.05 I $972.60 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, January 15, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund