252248 12/08/15 W.G�q .
��' '� CITY OF CARMEL, INDIANA VENDOR: 361470
1 CHECK AMOUNT: S`•'"1,374.50`
.�; ® :�•_ ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 252248
M��rori.�O. MEDINA OH 44256 CHECK DATE: 12/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 33234 270066 1,374.50 CARSEAT HARNESS ETC
MERCURY Invoice
DISTRIBUTING j
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000270066
REMITTANCE ADDRESS:
WESTERN RESERVE DISTRIBUTING,INC. Invoice Date: 11/13/2015
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 12/13/2015
MEDINA,OH 44256
Customer: CARMPD
Tax ID#82-0563593q Sales Order: 0000148278
% '"��. '� r�.�; ,4 •k��e-" `� , '"� i 4a2d�.s..���+x;;r ;..r•„`S� i�=j'�„ �ee,,,� y�i� ': '`bs�'� ,L, 'z°� •�;�; `r.
CARMEL POLICE DEPARTMENT,CITY N TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH ST SUITE B
CARMEL,IN 46032-2584 USA Carmel,IN 46032 USA
'.3,C. .�a` -.P,*.c�t
33234 LTL-OLD DOM ORIGIN Net 30 Days
za;. +IteiY1� t�� Lr.1:...r �u"r N �'1' t10I1$+`y;p,.k:+5:ry��.,.. �x .'dam• _ xr»•' Ill- e ��' ":. *.,��'.-X._ " �,:�
IC20IDFC Safety 1st OnBoard 35(4-35 lbs)with adjustable I 1 i $ 84.0000 $ 84.00
base and up front adjust I
3702098 TITAN 5 CARSEAT 50#213K i 8 ! $ 57.7500 $ 462.00
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER 8 $ 14.9000 ! $ 119.20
PACK) !
3062198 Chase Factory Select Harnessed Booster Car Seat 2 6 ' $ 47.1000 $ 282.60
pack i
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 6 ; $ 26.9500 I $ 161.70
Booster Car Seat,Factory Select 2 pack
------------------------------------ ------------------------------------------ LAST ITEM -----------------------r---------------------- ---------- ------------------
a
' I
! � 1
• i I
I -
i
i 1
� ! I
i I i
I �
i
Tracking Numbers: 32502027082
Subtotal 1,109.50
LIFT GATE&INSIDE DEL Freight 265.00
Sales Tax 0.00
Discount 0.00
Payment/Credit 0.00
��;� � <..,•�: �:�� � - £:K� - �Y+3-?� ,:.rr� �:��s�`.�'�'rF - �'�
um •, _J`µ_l� tii.: 1,374.50
City
® (� Carmel INDIANA RETAIL TAX EXEMPT PAGE
,Jlr CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 3M
,h 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
Ii/0209S
Child Rource COMM Police DOPER font
Wootlern R000r o Dishibutln0, Inc. SHIP 3 CIVIC Squaim
VENDOR
Laho Rd TO Cumol, IN 4
Modina, OH 44266 671-2M
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00D.06
9 Each shipping charges $265.00 $265.00
1 Each Safety 1 st Onboard 35 IC201 DFC $84.00 $84.00
6 Each Chase Pd Hamess Booster 40-11 Olbs 3431198 $26.05 $181.70
6 Each Chase Factory Select Hamessed 80 �8 - $47.10 $282.60
Booster
8 Each Eaddess Shieldless Booster 01:i'9QFiW /���� . $14.90 $119.20
8 Each Than 5 Carseat °°°370x098 $57.75 $462.00
Scab Total: $1,374.50
Uri
Send Invoice To:
Carmol Police Department
Attn: Pat Young
3 CIVIC square
Carol, IN 4 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. .r �> PAYMENT $1,374.50
S A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFT+FSTHERE IS ANS NOBLIGATED BALANCE IN
THIS APPROPF31 Tj��jN UFFICIEN TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. //!/J/JA
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY dery p�,(/,,
SHIPPING LABELS. Fy@q
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE V
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
e
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
=1
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.
t
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
11/13/15 0000270066 car seats $1,374.50
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
VOUCHER NO. WARRANT NO.
I
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF $
305 Lake Rd
Medina, OH 44256
$1,374.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
33234 I 0000270066 I -590.05 I $1,374.50 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
Thursday, December 03, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund