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Home My WebLink About180774 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1 A pp, O NE CIVIC SQUARE CHILD SOURCE CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $577.30 c MEDINA OH 44256 CHECK NUMBER: 180774 CHECK DATE: 12/30/2009 •EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 852 5023990 21282 141841 59.09 CAR SEATS ",`900 4359005 21282 141841 518.21 CAR SEATS I chid source' Invoice WI FRCURY nISTB rsuTi xc Invoice Number: 0000141841 7001 Wooster Pike, Medina, 01-1 44256 Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 12/10/2009 REMITTANCE ADDRESS: Invoice Due Date: 1/9/2010 WESTERN RESERVE DISTRIBUTING, INC. dba CHILD SOURCE Customer: CARMPD P.O. BOX 737I4 Sales Order: 0000089842 CLEVELAND, OH 44193 Tax ID #f82- 0563593 1 S'old ��a'�4� r�` °3 Sly To, CARMEL POLICE DEPARTMENT, CITY OUR LADY OF MT CARMEL TRINITY 3 CIVIC SQUARE 1045 W 146TH STREET CARMEL, IN 46032 -2584 USA MAGGIE 317- 819 -0772 Carmel, IN 46032 USA Customer P.O.' „�,�5hip�Via swFOB� "tTeims,,�z3 i� 21282 FEDEX GRND ORIGIN Net 30 Days x ea jten]' ti wxl �'��I`��i t C� s t�'�aC AROUI]t •A'.. De'scriprion g Qtv�Shipped`w Unit i 3321198 EVENFLO EMBRACE INFANT SEAT 2 j 65.800 131.60 93- 120FSM SCENERA 4 HNS POS (2/PK) 4 43.000 172.00 93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 4 47.200 188.80 LAST ITEM Tracking Numbers: 066443711832724, 066443711832731, 066443711832748, 066443711832755, 066443711832762, 066443711832779 MULTIWEIGHT Subtotal 492.40 Freight 84.90 Sales Tax 0.00 Payment/Credit Amount 0.00 P w 1 ;B alance 577.30 U U� A INDIANA RETAIL TAX EXEMPT PAGE l l 1 Of C arme l CERTIFICATE NO. 003120155 002 0 1 s Carmel PURCHASE ORDER NUMBER 4 Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 1282 3ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP 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 December 8, 2009 car seats SHIP VENDOR Child Source TO Our Lady of Mount Carmel. 7001 Wooster Pike Trinity Clinic Medina, OH 44256 1045 W. 146th Street Carmel, IN 46032 MAGGIE 317 -819 -0772 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY IUNITOF MEASURE I DESCRIPTION UNIT PRICE 1 EXTENSION 2 3321198 Evenflo Embrace Infant Seats 65.80 131.60 4 93- 120FSM Scenera 4 Hns Pos 42.00 172.00 4 93- 209FBM High Back Booster Front adj 47.00 188.00 590 -05 $518.21' 852 58.29 1 I 1 a te, 4,, r „„4 il 6 Send Invoice To: City of Carmel Poi ,r,, ,e -,0 ATTN: Teresa Anderson' 3 Civei& Squarew Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE 576.50 DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1 900 590-05 car seat grant PAYMENT 852 852 polide gift fund iv" NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS 1 t I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. SHIP REPAID. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. 1-44A f, PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY ib f f-' a 11 4 J`. SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of POlice AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 L CLERK- TREASURER DOCUMENT CONTROL NO. L A. CO PY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO.___ WARRANT NO. ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR •.4 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 Child Source Purchase Order No. 21282F 7001 Wooster Pike Terms Medina, OH 44256 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 12/10/09 141841 payment for car seats 577.30 Total 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. ALLOWED 20 Chi;_d Source IN SUM OF$ 7001 Wooster Pike Medina, OH 44256 577.30 ON ACCOUNT OF APPROPRIATION FOR police grant, furid police general fund Board Members Po# or INVOICE NO. ACCT #,TITLE AMOUNT hereby certify invoice( s), oEr. I hereb certif that the attached invoices or 21282F 141841 590 -05 518.21 bill(s) is (are) true and correct and that the 21282F 141841 852 59 .09 materials or services itemized thereon for which charge is made were ordered and received except December 17 20 09 *.t. D 4 Signature Chief of POlice Title Cost distribution ledger classification if claim paid motor vehicle highway fund