250615 10/21/15 t CITY OF CARMEL, INDIANA VENDOR: 361470
® `1 ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: S""'"657.00'
CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 250615
*,`TON�:i MEDINA OH 44256 CHECK DATE: 10/21/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 33166 0000266300 657.00 CARSEAT BACK BOOSTER
_q0VMERCURY Invoice
DISTRIBUTING
305 Lake Road, Medina,OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Number: 0000266300
REMITTANCE ADDRESS:
Invoice Date: 9/28/2015
WESTERN RESERVE DISTRIBUTING. INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE 10/28/2015
305 LAKE RD Invoice Due Date:
MEDINA.OH 44256
Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000146289
Sold To Ship To
CARMEL POLICE DEPARTMENT. CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 14TH STREET
ATTN :PAT YOUNG SUITE B
CARMEL. IN 46032-2584 USA Carmel, IN 46032 USA
- '. Customer P-U:� _ - Ship V"ia -� - • '. �`P:O:B--J _ ` -` - --�TeimsV"' -`- 'V"-`1
33166 UPS ORIGIN Net 30 Days
Item Description Qty Shipped Unit Price Amount
IC086BRV Safety I st OnBoard 35 (Weight range 4LB - 35 lbs) 5 $ 84.0000 $ 420.00
3702098 TITAN 5 CARSEAT 50#2PK 2 $ 57.7500 $ 115.50
3414198 AMP NO BACK BOOSTER 40-1104 2 $ 15.7000 $ 31.40
- LAST ITEM ------------------------------------------------------------
Tracking Numbers: 1 ZA7T6670395122394, 1 ZA7T6670396013607, 1 ZA7T6670396294573, 1 ZA7T6670396570621, 1 ZA7T66
Subtotal 566.90
Freight 90.10
Sales Tax 0.00
Discount 0.00
PLEASE NOTE NEW REMITTANCE Payment/Cred it Amount 0.00
ADDRESS ABOVE _Balance-Due' 657.00
/�° Carmel
INDIANA RETAIL TAX EXEMPT PAGE
Ci� ®1Jlr CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 33166
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
@hill O@um@ Camol Pollco Dopmtmont
Wbstwn RGUONG DIIt11buting, Inc. SHIP 3 CIVIC squm
VENDOR
Lako Fid TO CIMG1' IN
Miodlnm, ON 44M (Zq9)571
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00 .06
2 Each amp no back booster 40-1101bs 3414108 $15.70 $31.40
1 Each shipping $00.10 $00.10
2 Each Than 5 Carseal 3702008 $57.75 $115.50
5 Each Sammy 1 s4 on board 4-351b =869111 $84.00 $420.00
Bub Total: $857.00
°
Send Invoice To: 0 �
Cumol Pollco DOPER rlGnk �
Attn: Pat Young
3 CIVIC Squama
C GI' IN - PLEASE INVOICE IN DUPLICATE
DEPARTMENT n ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel FolIC0.90PI.
L PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION UFFI
SHIP REPAID. CIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY / , �y
SHIPPING LABELS / - 1(°cfl�/�F polleo
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE f!//
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 3 316 6 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
CL
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
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))
09/28/15 0000266300 Car Seats $657.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF $
305 Lake Rd
Medina, OH 44256
$657.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
33166 0000266300 -590.05 $657.00 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
Tuesday, Oct er 06, 2015
41Z Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund