HomeMy WebLinkAbout189280 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
0 ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $971.85
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA ON 44256 CHECK NUMBER: 189280
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26995 159786 971.85 CAR SEATS
S
�r,�� ounce Invoice
Invoice Number: 0000159786
7001 Wooster Pipe, Medina, 0I9 44256
Ph: 330.723.4739 Fax: 330.721-6799 Invoice Date: 8/13/2010
REMITTANCE ADDRESS: Invoice Due Date: 9/12/2010
WESTERN RESERVE DISTRIBUTING, INC. Customer: CARMPD
dba CHILD SOURCE
P.O. BOX 73714 Sales Order: 0000095054
CLEVELAND. 0I -1 44193
Tax ID #82- 0563593
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TF1 STREET
CARMEL, IN 46032 -2584 USA ATTN MAGGIE 317 -819 -0772
Carmel, IN 46032 USA
CiIstomcr Pf3 "Shi Uta t�
w
a p :h.O.B
26995 FEDEX GRND ORIGIN Net 30 Days
_Descn ...m �..m a Zty� Sliip `[Jni %Price`. A_ mount
fCO34AOB SAFETY Ist DESIGNER CARSEAT 5 -224 W /BASE 2 63.9000 127.80
(NORDICA)
93 12OFSM SCENERA 4 HNS POS (2 /1 1 43.0000 430.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 21 47.2000 94.40
93 -21 1 FSM VOYAGER HIGHBACK (2 PER PACK) 6 28.9000 173.40
LAST ITEM
Tracking Numbers: 066443712151527, 066443712151534, 066443712151541, 066443712151558, 066443712151565,
066443712151572, 066443712151589, 066443712151596, 066443712151602 ,066443712151619,
066443712151626
Subtotal 825.60
Freight 146.25
Sales Tax 0.00
Payment /Credit Amount 0.00
%a ancel 971.85
INDIANA RETAIL TAX EXEMPT PAGE 1 of 1
City ®f Carme� CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 26995 I
3M 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.
3 URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
August 11 2010 car seats
v
I
VENDOR Child Source SHIP Trinity Clinic
7002 Wooster Pike TO 1045 W. 146th Street
Medina, OH 44256 Carmel, IN 46032
ATTN: Maggie 317419 4772
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
2 ICO34AOB Safety 1st Designer Carseat 5 -224 w /base 63.90 127.80
10 93- 12OFSM Scenera 4hns pos 43000 430.00
2 93- 209FSM High Back Booster front adj 47..2.0 94.40
6 13- 21FESM Voyager Highback 28.90 173.40
shipping 146.25
A s
`N
City of Carmel Poie;Depar�}et` µM,�
Send Invoice To:
ATTN: Teresa Anderson.
3 Civic Square
Carm& IN 46032
I
PLEASE INVOICE IN DUPLICATE 971.85
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
900 590-05 car seat grant filn PAYMENT
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 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. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Chief Of Po i C e
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
0 CLERK- TREASURER
C 9
DOCUMENT CONTROL NO. 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
Pill(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. 26995F
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/13/10 15 786 a etn for carseats 971,85
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
VOI.^CHER NO. WARRANT NO.
ALLOWED 20
Child Source IN SUM OF
7001 Wooster Pike
Medina, OR 44256
971.85
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
26995F 159786 590 -05 971.85 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
August 12 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund