186769 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,794.75
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINAOH 44256 CHECK NUMBER: 186769
CHECK DATE: 6/2312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 26929 155649 10.35 CAR SEATS
900 4359005 26929 155649 1,784.40 CAR SEATS
chl�ld source' Invoice
Invoice Number: 0000155649
7001 Wooster Pike, Medina, 01 -1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 6/9/2010
REMITTANCE ADDRESS: Invoice Due Date: 7/9/2010
WESTERN RESERVE DISTRIBUTING, INC. Customer: CARMPD
dba CHILD SOURCE
P.O. BOX 73714 Sales Order: 0000093629
CLEVELAND, OH 44193
Tax ID 482- 0563593
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ATTN ANN
Carmel, IN 46032 USA
R
`M
26929 LTL ESTES ORIGIN Net 30 Days
Snapped Hit _P e; �lnidu
ICO34A0B SAFETY Ist DESIGNER CARSEAT 5 -224 W /BASE 15 63.9000 958.50
(NORDICA)
93- 120FSM SCENERA 4 I -INS POS (2 /PK) 14 43.0000 602.00
22- 12OFSM SCENARA I PK CARSEAT 1 43.0000: 43.00
—W LAST FIT
Tracking Numbers: 155 1068338
Subtotal 1,603.50
lift gate &inside del Freight 191.25
Sales Tax 0.00
Payment/Credit Amount 0.00
FE R R ENTiR6 L794.75
C' INDIANA RETAIL TAX EXEMPT PAGE
Car e CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 26929
3Q =CIVIC 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
Julie 8, 2010 car seats
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 PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
15 ICO34AOB Safety 1st Designer carsean 5 -22# w /base 63.90 958.50
14 93- 12OFS14 Scenera 4hns pos 43.00 602.00
1 22- 12OFSM Scenara 43.00
shipping 191.25
Q
1}
A
582 10.35
590-05 $1,784.40
A
•a�.,
City of Carmel Pol ce- ;IIePetn
Send Invoice To:�
ATTN: Teresa Anderson
3 Civic Square
Caramel, IN 46032
PLEASE INVOICE IN DUPLICATE 1, 794.75
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
9 -90 590 -05 car seat grant PAYMENT
1110 polio gift fund A/P VOUCHER -1-0 T BE APPROVED FOR PAYMENT UNLESS THE P.O.
.;9�•�,,� 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
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 ORDE ED BY f/ tt 1 I
SHIPPING LABELS.
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. 2 6 9 2 A.P.V. COPY SIGN AND RETURN TO CLERK OFFICE
VOUCHER NO.___ WARRANT 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__
A 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. 26929F
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/9/10 155649 payment for car seats 1,794):75
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
1,794.75
ON ACCOUNT OF APPROPRIATION FOR
grant
p olice XKKK M f p olice gen fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
26929P 155649 590 -05 1 784.40 bill(s) is (are) true and correct and that the
26929F 155649 852 10.35 materials or services itemized thereon for
which charge is made were ordered and
received except
June 16 20 10
�.1
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund