308074 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 361470
® \ ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $*******997.65*
r• ;�a; CARMEL, INDIANA 46032 305 LAKE ROAD CHECK NUMBER: 308074
MEDINA OH 44256 CHECK DATE: 02/13/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 100087 0000309345 997.65 BOOSTER SEATS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 361470 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
CHILD SOURCE IN SUM OF$ CITY OF CARMEL
305 LAKE ROAD 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.
MEDINA, OH 44256
Payee
$997.65
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DE719F INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100087 0000309345 50-239.90 $997.65 1 hereby certify that the attached invoice(s),or 1/30/17 0000309345 car seats $997.65
1110 852 1110 852
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, February 10,2017
Green,Tim
Chief of Police
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
MERCURY Invoice
DISTRIBUTING
305 Lake Road,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000309345
REMITTANCE ADDRESS: Invoice Date: 1/30/2017
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE
305 LAKE RD Invoice Due Date: 3/1/2017
MEDINA,OH 44256 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000166025
Ship To
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC-ANN GALLAGHER
3 CIVIC SQUARE 146TH STREET SUITE B
ATTN: ANN GALLAGHER DELV MON-THURS 9-5,FRI 9-12
CARMEL,IN 46032-2584 USA Carmel,IN 46032 USA
s tomer=P:O -- r YSh►p'Via.:: ---;"='. F.O:B _. _ Ternis _.-.
100087 UPS ORIGIN Net 30 Days
x , Item Description _ ___ _ Qty Shipped4 Unit Price Amount
IC20ICHZ OnBoard 35(4-35 lbs)with adjustable base and up 3 $ 84.0000 $ 252.00
front adjust
3702098 TITAN 5 CARSEAT 50#2PK 2 $ 57.7500 $ 115.50
3102198 MAESTRO 50 COMBINATION BOOSTER SEAT 6 $ 58.3000 $ 349.80
(20-100lbs)
3431198 Chase No Harness 40-110 lbs Booster Seat,FSM 2 2 $ 26.9500 $ 53.90
pack
3701198 TITAN 5 CARSEAT 50# 1 P 1 $ 57.7500 $ 57.75
LASTITEM ---------------------------------------------------------------------------------
Tracking Numbers: 1ZA7T6670395176372, 1ZA7T6670396342234, 1ZA7T6670396356194, 1ZA7T6670397203409, 1ZA7T66
Subtotal 828.95
Freight 168.70
Sales Tax 0.00
Discount 0.00
P.ft, NOTENEWtREMITTANCE °` Payment/CreditAmount 0.00
ADDRES%S ABO�/E Balance Due 997.65
K� _