244898 05/05/15 'y,..�e,,,� CITY OF CARMEL, INDIANA VENDOR: 361470
ttl ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******373.01'
�� ,=q; CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 244898
��'�ir6ii"�°' MEDINA OH 44256 CHECK DATE: 05/05/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 32851 0000252658 373.01 BOOSTERS AND CAR SEAT
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000252658
REMITTANCE ADDRESS: Invoice Date: 4/20/2015
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 5/20/2015
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000138607
Sold To
Ship To
CARMEL POLICE DEPARTMENT,CITY CARMEL POLICE
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL,IN 46032-2584 USA A GALLAGHER 317-571-2720
Carmel,IN 46032 USA
f- --_�CuHoffcr P.O.
32851 UPS ORIGIN Net 30 Days
--Item Description Qty Shipped Unit Price Amount
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 2 $ 77.4000 $ 154.80
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER 4 $ 14.9000 $ 59.60
PACK)
3431198 Chase No Harness 40-110 lbs(I 8-49,8kg) 4 $ 26.9500 $ 107.80
Booster Car Seat,Factory Select 2 pack
--------------------------------------------------------------------------------- LAST ITEM ---------------------------------------------------------------------------------
Tracking Numbers: 1ZA7T6670396899223, 1ZA7T6670397953046, 1ZA7T6670398847258, 1ZA7T6670399151668, IZA7T66
Subtotal 322.20
Freight 50.81
Sales Tax 0.00
Discount 0.00
PLyEAS{E cE,>' ' Payment/Credit Amount 0.00
ff
A 373.01
A-Bov
:',7
INDIANA RETAIL TAX EXEMPT PAGE
Chit ®f Carmel .,
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 3-981
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
4/17t2015
Child Souva@ ewmel Polices Department
VENDOR SHIP S ClVie Square
7001 Wooster Pike TO Carmel, IN 460
Medina, OH 442 (517 571-2560
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-02.00
1 Each Shipping $50.81 $50.81
Each backless shieldless booster(4pk) 93-299FSIVI $14.90 $59.61
Each On Board 35 Infant Car Seat IC06817W ! 'I'1.4o \5l .go
4 Each Chase factory select harnessed booster-5% �
-- - _ -
31r� 2k .ws
I �?2pk Z.
9Jj _ ; b Total: 3 C r
l
Send Invoice To: r"( VS,,
Carmel police Department
Attn: Pat Young
S CNIc Squares
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT ---AMOUNT
Carmel Police Dept.
PAYMENT - --
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRI TION UFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY 9 C�
SHIPPING LABELS. 111@,7 of Palle@
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL No- 32851 1 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
T IN THE SUM OF$
Ca_,
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
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF$
709+Wouste, Pike—
Medina, OH 44256
$373.01
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Gift Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32851 I 0000252658 I -852.00 I $373.01 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, April 29, 2015
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))
04/20/15 0000252658 car seats $373.01
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