159482 05/14/2008 i
CITY OF CARMEL, INDIANA VENDOR: 355237 Page 1 of 1
ONE CIVIC SQUARE MERCURY DISTRIBUTING
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $782.95
MEDINA OH 44256 CHECK NUMBER: 159482
CHECK DATE: 5/14/2008
DEPARTMENT J A PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 17417 96686 782.95 CAR SEATS
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ild source Invoice
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08iffisimimma Invoice Number: 0000096686
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 5/1/2008
REMITTANCE ADDRESS: Invoice Due Date: 5/31/2008
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000075328
CLEVELAND, OH 44193
Tax ID #82-0563593
Sold To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT, CITY
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032-2584 USA CARMEL, IN 46032-2584 USA
A
�rfns
Q!Is oMeL 0 Sh' V* .,A
17417. FEDEX GRND ORIGIN Net 30 Days
Item `y Description Qti$hi� ed- "Uh&Price, fit
�,��,'Descr
22-311WAL SAFETY 1st INFANTCAR SEAT 5-22# W/BASE 5 49.750 248.75
93-12OFSM +SCENERA 4 HNS POS (2/PK) 6 39.900 239.40
93-299FSM 1 +BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 12 14.750 177.00
LAST ITEM
Tracking Numbers: 066443711033220, 066443711033237, 066443711033244, 066443711033 066443711033268,
066443711033275,066443711033282,066443711033299,066443711033305,066443711033312,
066443711033329
Subtotal 665.15
Freight 117.80
Sales Tax 0.00
Payment/Credit Amount 0.00
B a lance 782.95
C f INDIANA RETAIL TAX EXEMPT PAGE
C of! a rme l CERTIFICATE NO. 003120155 002 0 1 11 JL PURCHASE ORD
NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 17A17
3 XO' NE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
f
APril -2, 2008 car seats
VENDOR Meauuty Distributing SHIP City of Carmel Police Department
7001 Wooster Pike TO 3 Civic Square
Medina, OH 49256 Carmel, IN 46032
ATTN: Ann Gallagher
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
5 22- 311WAL Safety 1st Infant carseat 5 -22# w /base �j, 49.75 248.75
6 93- 12OFSM Scenera 4 has pos a -39.90 239.40
6 3702098 Titan 5 carseat 50# 61.15 366.90
12 93- 299FSM Backless shieldless booster 14.75 177.00
shipping 7- r 182.78
3 .sum.; s
Pe rmanent F•it$m
P
c4`
City of Carmel Po °Lce DepiartodAt
Send Invoice To: ATTN: Teresa Anderso�t
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
1.214.83
DEPARTMENT ACCOUNT PROJECT j PROJECT ACCOUNT AMOUNT
900 590 -05 car seat grant PYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
J 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.
r a
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. i
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY t
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
y CLERK- TREASURER
DOCUMENT CONTROL NO.1 4 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
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
.Mercury Distributing Purchase Order No. 17417P
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/1/08 96686 payment for car seats 782.95
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
M e.%cury Distributing IN SUM OF
7001 Wooster Pike
Medina, OH 44256
782.95
ON ACCOUNT OF APPROPRIATION FOR
police grant fund
Board Members
INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
17417P 96686 590 -05 782.95 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
May 7 20 08
Signature
Chiefoof Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund