245082 5 /13/2015 +pr.C.1A'�
u® CITY OF CARMEL, INDIANA VENDOR: 361470
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******733.70*
_�; CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 245082
9�`_ /. MEDINA OH 44256 CHECK DATE: 05/13/15
rroN co'
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 32856 253144 733.70 BOOSTER CAR SEAT
MERCURY Invoice
DISTRIBUTING
305 Lake Road, Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000253144
REMITTANCE ADDRESS: Invoice Date: 4/27/2015
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE 5/27/2015
305 LAKE RD Invoice Due Date:
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593Sales Order: 0000138795
Ship To,
CARMEL POLICE.DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAK RIDGE ROAD
CARMEL,IN 46032-2584 USA Carmel,IN 46032 USA
a
32856 UPS ORIGIN Net 30 Days
Item '; Description _Qty_Shipped_ Unit Price Amount
IC086BXT Safety 1st OnBoard 35 (Ross)(Weight range 4LB-35 4 $ 84.0000 $ 336.00
lbs)
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: 1 ZA7T6670390552876, 1 ZA7T6670390941651, 1 ZA7T6670391272864, 1 ZA7T6670392735291, 1 ZA7T66
Subtotal 632.20
Freight 101.50
Sales Tax 0.00
Discount 0.00
9%24PLEASE NOT NM REMITTANCE Payment/CreditAmount 0.00
f - ADDRESS A190VE' " ` salanceDue 733.70
(�° Carmel
INDIANA RETAIL TAX EXEMPT PAGE
City ®,Jlr CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
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
WW201 J
I
estom R@sofv@ Distributing, Inc. 3 Civic Sq�r re`
VENDOR SHIP � ,u, `
�e
`10p Lake R TO Car�rroi )l} 46
0&
OH 449-66 071. x`14'W_
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account ffi-M.05
1 Each shipping charges $101.50 $101.50
4 Each Chase Factory Select &amessed 3062190 $47.10 $18S.40
Booster
4 Each Chase No Harness Booster 40-110Ihs $20.05 $107.80
4a3�1
4 Ear4r Safe1 1i�`�.3MW- $84.00 $336.00
$Fj 1st on board � ; %
E �
�,�; t Soh Total: $733.70
69
u M 9
1@L �
1'
t
Send Invoice To: µ✓
Carrel Police Dopaitmmnt
Aftn: Pat`young
3 CIVIC squ
Carmel, IN 46032® PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
Carmel Police Dept. *r .fu
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. —�
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED
SHIPPING LABELS. `._ \ ,\ ChI@F of Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE-
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO- 32856 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO._—._---WARRANT NO. _
ALLOWED 20
IN THE SUM OF$
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
�._ Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF$
i
305 Lake Rd
Medina, OH 44256
$733.70
ON ACCOUNT OF APPROPRIATION FOR
I Police Grant Fun
Carmed
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32856 0000253144 -590.05 $733.70
I hereby certify that the attached invoice(s), or
I I I
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
Friday May 08, 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))
04/27/15 0000253144 car seats $733.70
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