181850 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
fa ii ONE CIVIC SQUARE CHILD SOURCE
j CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $1,597.80
4:1 --cei MEDINAOH 44256 CHECK NUMBER: 181850
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 21322 144042 1,597.80 CAR SEATS
Ciusource
Invoice
MERCURY DISTRIBUTING Invoice Number: 0000144042
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 1/15/2010
REMITTANCE ADDRESS: Invoice Due Date: 2/14/2010
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000090485
CLEVELAND, OH 44193
Tax ID #82- 0563593
Sold To: Ship 4 1
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ATTN ANN GALLAGGER
Carmel, IN 46032 USA
1.
21322 LTL VITRAN ORIGIN Net 30 Days
Item „ti e` 1, E 1 i' 41 „Qt Shipped Unit Pnce., t Amount x
IC041LGA SAFETY 1st DESIGNER CARSEAT 5 -22# W/BASE 6 63.900 383.40
22- 453FSM 3 -PHASE CONVERTIBLE CAR SEAT 4 75.650 302.60
93- I20FSM SCENERA 4 HNS POS (2/PK) 6 1 43.000 258.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 47.200 377.60
22- 530FSM APEX 65 BOOSTER SEAT 5 PT HNS 1 111.400 111.40
22- 120FSM SCENARA 1 PK CARSEAT 1 44.000 44.00
LAST ITEM
Tracking Numbers: 00378360432
Subtotal 1,477.00
Freight 120.80
Sales Tax 0.00
Payment/Credit Amount 0.00
B °alance 1,597.80
City INDIANA RETAIL TAX EXEMPT PAGE
o l l CERTIFICATE NO. 002 0 1 of 1
1L PURCHASE ORDER NUMBER
Police Department
FEDERAL EXCISE TAX EXEMPT
35- 60000972 213/2
30NE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A!P
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
.January 14, 2010 car seats
VENDOR Child Source SHIP Cit of Cmamw1,Po1ice Department
7001 Wooster Pike TO 3 Civic Squaae
Medina, OH 44256 Carmel, IN 46032
ATTN: Ann Gallagher
CONFAMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
6 IC041LGA Safety 1st Designer Carseat S -22# w /base 63.90 383.40
4 22- 453FSM 3 -Phase Convertible Carseat 75.65 302.60
6 93-- 120FSM Scenera 4hns Pos 43.00 258.00
8 93- 2O9FSM High Back Booster front adj 47.20 377.60
1 22- 500FSM Apex 65 Booster seat 5•tHs 11 111.40
1 22- 12OFSM Scenara 1pk carne 44.00
shipping
120.80
mow
ill, Isi 1111111
S w
-1 4‘
Fzr ,p 4 4 v t t ,4 1 I Op
Mf> 40
City of Carmel Po t
Send Invoice To: ATTN: Teresa Anders
3 Civic Square
Cammel, IN 46032
PLEASE INVOICE IN DUPLICATE 1,597.80
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
900 590-05 car seat grant PAYMENT
AP 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 SUFFICIENT TO PAY FOR THE ABOVE ORDER'.
SHIP REPAID. 1
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ti PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY !/i! /4 J rr izi;7 .P•_
SHIPPING LABELS. 7 t+
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO
CLERK- TREASURER
DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO_ WARRANT
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members 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. 21322F
7001 Wooster pike, Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/15/10 144042 paymetn for car seats 1.597.80
Total
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
Chid Source IN SUM OF
7001 Wooster Pike
Medina, OH 44256
1,597.80
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
D PT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
21322F 144042 590 -05 1,597.80 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
January 27 20 10
*iet14111-b
Signature 744.4
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund