184227 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
0 ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $1,082.80
MEDINA OH 44256
CHECK NUMBER: 184227
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 21870 150650 80.60 CAR SEATS
900 4359005 21870 150650 1,002.20 CAR SEATS
moI d soup -be- Invoice
s Invoice Number: 0000150650
7001 Woostcr Pike, Medina, 0I -1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 415/2010
REMITTANCE ADDRESS: Invoice Due Date: 5/5/2010
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000092191
CLEVELAND, OH 44193
Tax ID 482- 0563593
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ANN GALLAGHER
Cannel, IN 46032 USA
17SL(t1T1Cly a Ili�225001'
21870 FEDEX GRND ORIGIN Net 30 Days
ICO34AOB SAFETY Ist DESIGNER CARSEAT 5 -22# W /BASE 6 63.9000 383.40
(NORDICA)
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 47.2000 377.60
93- 211FSM VOYAGER HIGHBACK (2 PER PACK) 6 29.900 0 179.40
LAST HT,,,M
Tracking Numbers: 066443711983792, 066443711983808, 066443711983815, 066443711983822, 066443711983839,
066443711983846, 066443711983853 ,066443711983860, 066443711983877 ,066443711983884,
066443711983891, 066443711983907,066443711983914
Subtotal 940.40
Freight 142.40
Sales Tax 0.00
Payment/Credit Amount 0.00
1082.80
Ci INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE Np. 003120155 002 0 1 f PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 7
30-R-E SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A!P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Al2 ril 1. 2010 carseears
VENDOR Child Source SHIP City of Carmel Police Department
7001 Wooster Pike TO 3.Civic Square.
Medina, OH 44256 Carmel, IN 46032
ATTN: Ann Gallagher
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
6 ICO34A�B Safety 1st Designer Carseat 2 --221P 63.90 383.40
8 93- 209FSM High Back Booster .front adj 47.20 377.60
03- 2T3F211FSH Voyager Highback 29.90 179.40
shipping 142.40
852 80.60
590-05` $1,002.20 c�
A° may,
rM
F
Send Invoice To: 'Ci of Carmel Po `e' are A
ATTN: Teresa Anders
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
852 852 police gift fund PAYMENT
900 590-05 c ar seat grant A/P 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 Y I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Polic
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. A.PQ COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
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
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 21870f
Purchase Order No.
5001 Wooster Pike
Terms
Medina, OH 44256
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/31/10 150650 payment for car seats, booster seats 1,082.80
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
Child Source
7001 Wooster Pike
IN SUM OF
Medina, OH 44256
1,082.80
ON ACCOUNT OF APPROPRIATION FOR
police gift fund
car seat grant
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. l hereby certify that the attached invoice(s), or
21870f 150650 852 80.60 bill(s) is (are) true and correct and that the
21870f 150650 590 -05 J11002.20 materials or services itemized thereon for
which charge is made were ordered and
received except
April 122010
A mm-,,or-,b t
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund