182798 03/03/2010 a "cam CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $1,191.10
MEDINAOH 44256 CHECK NUMBER: 182798
CHECK DATE: 3/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 21353 146763 1,191.10 CAR SEATS
e
i ild sources Invoice
Invoice Number: 0000146763
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 2/17/2010
REMITTANCE ADDRESS: Invoice Due Date: 3/19/2010
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000091160
CLEVELAND, OH 44193
Tax ID #82- 0563593
s Y�
S61d:T q �J'Ship T' i a_
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA ATTTN MAGGIE 317 819 -0772
Carmel, IN 46032 USA
Customer O B Terms`
A a
21353 FED.EX GRND ORIGIN Net 30 Days
ty Shipped, :x Un►t:Pnce fliriount
3321198 EVENFLO EMBRACE INFANT SEAT ax 3 65.800 197.40
93- 12OFSM SCENERA 4 FINS POS (2/PK) 8 43.000 344.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 47.200 377.60
93- 21IFSM VOYAGER HIGHBACK (2 PER. PACK) 4 29.900 119.60
LAST ITEM
j
1
Tracking Numbers: 066443711914543, 066443711914550, 066443711914567, 066443711914574, 06644371 1 91 4581,
066443711914598, 066443711914604 ,066443711914611, 066443711914628 ,066443711914635,
066443711914642, 066443711914659,066443711914666
MULTI WEIGHT Subtotal 1,03 8.60
Freight 152.50
Sales Tax 0.00
Payment/Credit Amount 0.00
1
C 0 INDIANA RETAIL TAX EXEMPT PAGE
ity o II C armel PURCHASE OR CERTIFICATE NO.003120155 002 0 zI DER 1 O NUMBE R 1i DER R
Carmel Police Departvent FEDERAL EXCISE TAX EXEMPT
35- 60000972 2135 3
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
e. r Ya v 6. 901 Car seat
VENDOR 13hild Source SHIP Crinity Clinic
7001 Wooster Pike TO 1045 W. 146th Street
Mddina, OH 44256 ATTN: Maggie 371 -819 -0772
Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
3 3321198 Fvenflo Embrace infant seats 65.80 197.40
8 93- 12OFSM Scenera 4hns Pos 43.00 344.00
8 93- 209FSM High Back Booster front a.dj 47.20 377.60
4 93- 211FSM Voyager Highhack 29.90 119.60
shipping 152.50
.Y
Send Invoice To:
City of Carmel Poke'
ATTN: Teresa Ander.so f
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 1,191.10
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
590 -05 900 590 -05 car seat grant .PAYMENT
A(P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P•0.
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., T
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ff y
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �1:'LC•`': G:[F {L.'
SHIPPING LABELS. Chief Of P ®lice
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
1 3 CLERK- TREASURER
DOCUMENT CONTROL NO. A COPY SIGN AND RETURN TO CLERK'S OFFICE
V91JCHER NO. NO.__
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
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
i
Cost distribution ledger classification it
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Farm No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
w 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. 21353F
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2/17/10 146763 pavment for car seats 1,191.10
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
C hild Source IN SUM OF
7001 Wooster Pike
Medina, OH 44256
1,191.10
ON ACCOUNT OF APPROPRIATION FOR
police grant fund
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
21353F 146763 590 05 1 ,191 .10 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
February 23 20 10
&�A Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund