191589 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
e ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,468.05
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
c o� io MEDINA OH 44256 CHECK NUMBER: 191589
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
852 5023990 163811 319.50 OTHER EXPENSES
900 4359005 27060 163811 1,148.55 CAR SEATS
cs a Inv oice
Invoice Number: 0000163811
7001 Wooster Pike, Medina_ 0I -1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 10/28/2010
RL'Mll "]'ANCE. ADDRESS:
Invoice Due Date: 11/27/2010
WESTERN RESERVE DISTRIBUTING, INC. Customer: CARMPD
dba CHILD SOURCE
P.O. BOX 73714 Sales Order: 0000096776
CLEVELAND, Oil 44193
Tax ID #82- 0 56359 3
!Sold T
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA Carmel, IN 46032 USA
..Custz��n U
Sli ia Terms
Ai
27060 FEDEX GRND ORIGIN Net 30 Days
Item Descri ption Q ty1Shtppe 7 Unit Pnce �Amo
ICO34AOB SAFETY 1st. DESIGNER CARSEAT 5 -22# W /BASE 5 63.9000 319.50
('NORDICA)
93- i20FSM SCENERA 4 HNS POS (2 /PK) 8 43.0000 344.00
93- 211FSM VOYAGER HIGHBACK (2 PER PACK) 8 28.9000 231.20
93- 2091 HIGH BACK BOOSTER FRONT ADJ 2PK 8 S 47.2000 377.60
LAST ITEM
i
Tracking Numbers. 066443715019138, 066443715019145, 066443715019152, 066443715019169, 066443715019176,
066443715019183, 066443715019190 ,066443715019206, 066443715019213 ,066443715019220,
066443715019237, 066443715019244, 066443715019251, 066443715019268,066443715019275
Subtotal 1.272.30
Freight 195.75
Sales Tax 0.00
Payment /Credit Amount 0.00
Balance 1,468.05
INDIANA RETAIL lt
CERTIFICATE NO 031 02 0 PAGE EXEMPT uy C me PURCHASE ORDER NUMBER
Y
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972
3 g=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.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO, VENDOR NO. DESCRIPTION
c&Zr seats
VENDOR Child Source SHIP N
TO
7001 Wooster Pike,. r
Medina, OH 44256 r. 1...
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
5 ICO34API Safety ist Designearcarseat 5 -22# 63090 319.50
4 93- 12OFSM Scenera 4hns pos 43.00 172.00
4 93- 211FSM Voyager highback 28.90 115.60
4 93- 209FSM High back booster front adj 47.20 188.80
shipping '/5 195.75
i {q
Af
582 n $319.50
590 -05 n $672.15
r AA
u%
Send Invoice To: City of Cannel Poll;rtR
ATTN: Teresa Anderson'
3 Civic Square
Carmel, IN 46032
l
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PRO_ JECT I PROJECT ACCOUNT AMOUNT
382 852 police gift fund PAYMENT
900 590-05 police grant f A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.Q.
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. R EKED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL v wv
C
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of PO' ice t
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK -TREASURER
DOCUMENT CONTROL NO. 2 7 0 6 0
A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
p�
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 ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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. 2706OF
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/28/10 163811 payment for car seats 1,468.05
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
C
86.05
ON ACCOUNT OF APPROPRIATION FOR
police gift fund /police grant fund
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
2706OF 163811 319.50 bill(s) is (are) true and correct and that the
2706OF 163811 590Y -05 1,148.55 materials or services itemized thereon for
which charge is made were ordered and
received except
November 4 20 10
Signature
Chief of Poli e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund