HomeMy WebLinkAbout255724 03/01/16 ,�,_CAq�f( CITY OF CARMEL, INDIANA VENDOR: 361470
Jt ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******438.96*
:. � CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 255724
9M?r'o"ri'�' MEDINA OH 44256 CHECK DATE: 03/01/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 33372 0000275752 438.96 TRINITY CLINIC - ONBO
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000275752
REMITTANCE ADDRESS: Invoice Date: 1/29/2016
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 2/28/2016
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000151009
Sold
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 w 146TH ST
CARMEL,IN 46032-2584 USA SUITE B
Carmel,IN 46032 USA
; Gust mer P,O 3, s Sfilp ViaR s I:0: x° - t ~ Temps arm a.
33372 UPS ORIGIN Net 30 Days
., x Unit Pnces Ainotint
ShigUL
�r Q
IC201CHZ OnBoard 35(4-35 lbs)with adjustable base and up 1 $ 84.0000 $ 84.00
front adjust
3702098 TITAN 5 CARSEAT 50#2PK 2 $ 57.7500 $ 115.50
3062198 Chase Factory Select Harnessed Booster Car Seat 2 2 $ 47.1000 $ 94.20
pack
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 2 $ 26.9500 $ 53.90
Booster Car Seat,Factory Select 2 pack
--------------------------------------------------------------------------------. LAST ITEM ---------------------------------------------------------------------------------
Tracking Numbers: 1ZA7T6670396021063, 1ZA7T6670396046448, 1ZA7T6670396370436, 1ZA7T6670399848657
Subtotal 347.60
Freight 91.36
Sales Tax 0.00
Discount 0.00
PLEASE NOTE NEW'REMITTANCE Payment/CreditAmount o.00
.,ADDRESS ABOVE438.96:
Balance�Due
vINDIANA RETAIL TAX EXEMPT Page 7 of 1
CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
i y o aTMC
FEDERAL EXCISE TAX EXEMPT 33372
ONE CIVIC.SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL,INDIANA 46032=2584 VOUCHER,DELIVERY MEMO;PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE '
FORM:APPROVED BY STATE BOARD"OF ACCOUNTS,FOR CITY OF.CARMEL-1997
PURCHASE_ORDER DATE DATE REQUIRED
REQUISITION NO. VENDOR NO. DESCRIPTION
1./22/2016 .361470
CHILD:SOURCE TRINITY CLINIC
VENDOR :305 LAKE ROAD. SHIP
TO 1045 W 146th.STREET
SUITE B
MEDINA-OH 44256= CARMEL, IN 46032
CONFIRMATION BLANKET CONTRACT, PAYMENTTERMS
QUANTITY. UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION.
Department: 1110 Account:. 436590:05 B�,rFun 0 Grant Fund �
2 Each 3062198. Chase factoryselect harnessed booster 2 pk :.$47.110.-. $94:20
Y. Each 3431198:. Chase-no harness 40-1101bs.booster 2pk: $26.95 $53.90 .
1. .Each'IC201CH.Z. OnBoard 35(4-35lbs)with adjustable'base $84:00: . . $84;00
1 .Each shipping charges $91.36 : $91136-
. -. .2:: Each 37.02098 : Titan 5_carseat.50#2pk $57.75 '$115.50
- Sub Total $438'..9-6.
Send Invoice To:
Carmel Police
'3 Civic Square
.Carmel,IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT. :
PAYMENT $438.96 . .
SHIPPING INSTRUCTIONS 'AIP 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
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS ANUNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION UFFICIENT TO PAY.FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
'THIS ORDER ISSUED IN COMPLIANCE WITH.CHAPTER 99,ACTS 194 .
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
TITLE
CONTROL NO. 3337-`2 CLERK-TREASURER.
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
01/29/16 0000275752 car seats $438.96
1110 900
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
CHILD SOURCE ALLOWED 20
305 LAKE ROAD IN SUM OF$
MEDINA, OH 44256
$438.96
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police
PO v Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
333720000275752 43-590.05 $438.96 I hereby certify that the attached invoice(s), or
1110 j
I 900
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
;j
Friday,.February 05, 2016
Cost distribution ledger classification if
claim paid motor vehicle highway fund