HomeMy WebLinkAbout197127 05/11/2011 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
0 f ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,962.20
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINAOH 44256 CHECK NUMBER: 197127
CHECK DATE: 5/1112011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTI
900 4359005 27792 171845 1,962.20 BOOSTERS /CAR SEATS
r c� ikd rce Invoice
INAMMAI Invoice Number: 0000171845
7001 Wooster Pike, Medina, 0I -1 44256
Ph: 330.723.4739 Far: 330.721.6799 Invoice Date: 4/26/2011
REMI "I ANCE ADDRESS: Invoice Due Date: 5/26/2011
WESTERN RESERVE DISTRIBUTING. INC. Customer: GARMPD
dba CHILD SOURCE'
P.O. BOX 73714 Sales Order: 0000100155
CLEVELAND, 01 -1 44193
"Fax ID #82- 0563593
Sold To 7 Ship To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ATTN ANN GALLAGHER 317 -5871 -2720
Cannel, IN 46032 USA
Gusto-mer Termfi
27792 LTL -ESTES ORIGIN Net 30 Days
Item Descri Q ty Shipped "Unit Price A mpuitt•
ICO34AOB SAFETY Ist DESIGNER CARSLAT 5 -22i W /BASE 9 63.9000 575.10
(NORDICA)
93 12OFSM SCEN1 4 HNS POS (2 /PK) 10 S 43.0000 S 430.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 21 10 S 47.2000 S 472.00
93-211 FSM VOYAGER HIGHBACK (2 PER PACK) 6 28.9000 173.40
93- 2991-SM BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 4 14.9000: 59.60
LAST I'T'EM
Tracking Numbers: 155- 1303972
Subtotal 1,710.10
LIFT GATE AND INSIDE_
Freight 2-52.10
Sales Tax 0.00
Payment /Credit Amount 0.00
r u °Balance 1.962.20
INDIANA RETAIL TAX EXEMPT PAGE
C 1� oCERTIFICATE NO. 003120155 002'0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT znI
35- 60000972
ONE 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
Child Soured C2rmol Polka Mpart ono
VENDOR SHIP 3 Ci Squmm
Mi Woos$0r Pllse T O 01911 IN 46
NOdirrda, OH 44 (317) 67i -25
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account (M i .fir
1 Each shipping $252.90 $252.90
4 Each Hackies$ Shieidless B ooste r 03- 200FSM $94.90 $50.00
0 Each !lager l°lighba ck 93-211 FSM $26.00 173.4 0
10 Each High Back Booster Front A4j 3 F $47.2 $4672.0
90 Each Scones 4 HN POS r I 3�a2o 4 $43.00 $430.00
0 Each So 9 se Designer Cor Sezlv I N B $63. 90 $575.10
Sub Total: $9,062,20
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Send Invoice To:
Carmel Pollce Depaitmont
Attn- Tomsm Anderson
3 Civic Square
C @mel, IN PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. X51 .z
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 CERTI �T�FI�TTHERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPR ON /SUFFICIENT TO PAY FOR THE ABOVE ORDER.
f/ I Y
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY g
SHIPPING LABELS. ia? of 6 pollc„o
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 2 7 7 92 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
Board Members
PD# or INVOICE NO. ACCT #(TITLE AMOUNT
aEPT. 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 higkway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
1, 96 2.2 0
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO# I Dept. INVOICE NO ACCT /TITLE AMOUNT Board Members
27792 171845 590.05 $1,962.20 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
Thursday, May 05, 2011
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by Slate 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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/26/11 171845 payment for car seats $1,962.20
1 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