244456 04/21/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 361470
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $•rsa*127980•
CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 244456
MEDINA OH 44256 CHECK DATE: 04/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 32822 0000250411 1,279.80 CAR SEATS BOOSTERS
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000250411
REMITTANCE ADDRESS: Invoice Date: 3/23/2015
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 4/22/2015
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000137281
:cSoldaTo s> Ship To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL,IN 46032-2584 USA A GALLAGHER 317-571-2500
Carmel,IN 46032 USA
>Gastomer'P 0
M9
32822
—
-
- y
32822 LTL-ABF ORIGIN Net 30 Days
Item Description Qty Ship-ped Unit Price},' Amount g
3152198 Embrace 35 Factory Select 6 $ 74.1500 $ 444.90
3712198 TITAN 65 CONVERTIBLE CARSEAT 2PK 6 $ 61.2000 $ 367.20
3062198 Chase Factory Select Harnessed Booster Car Seat 2 4 $ 47.1000 $ 188.40
pack
3431198 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: 065269537
Subtotal 1,108.30
LIFT GATE Freight 171.50
Sales Tax 0.00
Discount 0.00
; �PEi4SE NOTEfN'EW REMITTANCE Payment/CreditAmount 0.00
µ�: sYkf-ADDRExSSABOVE-rw —BaO ce-Due 1,279.80
INDIANA RETAIL TAX EXEMPT PAGE
City of
Carmel ..,� CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
.
FEDERAL EXCISE TAX EXEMPT 32622
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
3113P?Q95
Child Sourto rs;t t ' , .Dcipartirsklt
VENDOR SHIP ,�dffliJ #�rEl6i -
7001Wooster Pilo TO Cafmel,IN:.460321
Mina, Old 44256 671-256.9
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-852.00
4 Each Chase no harness 40-11Glbs booster 2pk 3431198 $26.95 $1107.80
1 Each Shipping $171.50 $171.50
4 Each-Chase factory select harnessed booster 3062198 $47.10 $188.4.0
Zak
i 0 i J/4/
6 Each Titan 65 convertlble carseat 2 ft -3712198 $611.24 $367.20
6 Each Embrace 35 Factory Select .���.; , i'31'5.2198 a'` ; , "��°>, $74.15 $444.90
Sub Total: $1,278.00
r
s ter
r <
Send Invoice To:
7-
✓./j
Cannel Police Department =
Atte: Pat Young
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT_ ACCOUNT AMOUNT
Carmel Police Dept. :....` PAYMENT $1,279.80
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS
• I HEREBY CERTIFY THATTF(ERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. �
THIS AP PROPRIATIOWSU.FICIENT TO�OR THE ABOVE ORDER.
• �
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY %
y
SHIPPING LABELS.
of THIS
pgpl�
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE I ( ff— 11
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 32822 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or 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
20
•— -------•--- Signature�--------•----...___
i
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF$
Medina, OH 44256
$1,279.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Gift Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32822 0000250411 -852.00 $1,279.80 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
Monday,April 13, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
j�
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))
04/13/15 0000250411 car seats $1,279.80
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