246244 06/17/15 ,0CITYOF CARMEL, INDIANA VENDOR: 361470
�/ \;•: ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*****1,392.30*
f ?� CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 246244
9,; MEDINA OH 44256 CHECK DATE: 06/17/15
F �SON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 32894 11392.30 SUPPLIES
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000255985
REMITTANCE ADDRESS: Invoice Date: 5/28/2015
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 6/27/2015
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000139499
Ship To
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL,IN 46032-2584 USA Suite B
Carmel,IN 46032 USA
=�G sei'P:B:
32894 LTL-ABF ORIGIN Net 30 Days
Item Description _Qty ShippedUnit Price Amount
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 6 $ 77.4000 $ 464.40
3062198 Chase Factory Select Harnessed Booster Car Seat 2 8 $ 47.1000 $ 376.80
pack
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 4 $ 26.9500 $ 107.80
Booster Car Seat,Factory Select 2 pack
3702098 TITAN 5 CARSEAT 50#2PK 2 $ 57.7500 $ 115.50
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER 4 $ 14.9000 $ 59.60
PACK)
--------------------------------------------------------------------------------- LAST ITEM ---------------------------------------------------------------------------------
Tracking Numbers: 065280360
Subtotal 1,124.10
LIFT GATE&INSIDE DEL Freight 268.20
Sales Tax 0.00
Discount 0.00
"" PLEASE NOTEkIVEWP REMITPTANCE Payment/CreditAmount 0.00
ADDRES,S,ABfOVE' # r =, BalanceDue_
l ' ' __ 1,392.30
INDIANA
L TAX EXEMPT
City
®� Carmel
CERTIFICATE 003 20155 002 0 PAGE
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 34
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
J827M15
Id Sourco Camiel Police Department
sterni Reserve Distributing, Inc. SHIP 3 Civic Square
VENDOR
305 Lake Rd TO Cancel, IN 46M
MedinaI, OH 442 (W)571-2559
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-690M
1 Each shipping $268.23 $268.20
6 Each On ideard36 Infant Car Seat IC068F'SM $77.40 $464.40
8 Each Chase FactorySeieci Harnessed 3062198 $47.10 $376.80
Booster
4 Each Chase No Harness rooster 40-1 1101b 313114 26.0 107.80
2 Each Titan 6 Carseat t wi ,? 20 '>tul /f ? $67,76 $116.60
4 Each rarysless Si�ieldls�ss Booster,`-.. ; n Q3=290FS1v1 $14.90 $59.60
4, Sub Total, $1,392.30
t
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IN
- `
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\V
Send Invoice To: �; _� -�rd 5)
},
Carmel Police Depa fflent
Attn: Pat Young
3 Civic Square
Camlel, IN 461432- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
Carmel Police Dept. 1r PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
v VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFFYITHATTHERE IS AN UNOBLIGATED BALANCE IN
THIS APPROP 77ATO SUFFICIENTTOPAY FOR THE ABOVE ORDER.
SHIP REPAID.C.O.D.SHIPMENTS CANNOT BE ACCEPTED. /PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY � ' L/
SHIPPING LABELS. CCC)�Ief Of Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE I/
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO- 32894 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
i
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$
305 Lake Rd
Medina, OH 44256
$1,392.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32894 I 0000255985 I -590.05 $1,392.30
I 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
Tuesday, June 09, 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))
05/28/15 0000255985 car seats $1,392.30
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