164649 10/16/2008 F CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,093.70
J, CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256
CHECK NUMBER: 164649
CHECK DATE: 10/16/2008
DEPARTMENT ACCOUNT PO NUMBER IN NUMBER T AMOUNT DESCRIPTION
900 4359005 18953 108443 1,042.46 CAR SEATS
900 4359005.:.18953 108447 51.24 CAR SEATS
�cKil sOu!' a Invoice
Invoice Number: 0000108443
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 9/29/2008
REMITTANCE ADDRESS: Invoice Due Date: 10/29/2008
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000079644
CLEVELAND, OH 44193
L Tax ID #82- 0563593
Skid To s
CARMEL POLICE DEPARTMENT, CITY CITY OF CARMEL POLICE DEPT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ANN GALLAG14ER 317 -571 -2720
PO #18953
Carmel, IN 46032 USA
Customer P O
f Sh�p,yia.`•3� .s. 77T
18953 i FEDEX GRND ORIGIN Net 30 Days
on
ti� Unit�Price Ari�ount:E~
w
a tv Sht eii
3292198 EXPRESS BOOSTER 2PK 30- 100# 2PK 4 51.250. 205.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 43.950: 351.60
93- 12OFSM SCEN.ERA 4 HNS POS (2/PK) 6 39.900 239.40
3321198 EVENFLO EMBRACE INFANT SEAT 2 59.750 1.19.50
LAST ITEM
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Tracking Numbers: 066443711247733, 066443711247740, 066443711247757, 066443711247764, 066443711247771,
066443711247788 ,066443711247795, 066443711247801, 066443711247818 ,066443711247825,
066443711247832
Subtotal 915.50
Freight 126.96
Sales Tax 0.00
Payment/Credit Amount 0.00
y]- •Balance 1,042,46
child source" Invoice
Invoice Number: 0000108447
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 9/29/2008
REMITTANCE ADDRESS: Invoice Due Date: 10/29/2008
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000079644
CLEVELAND, OH 44193
y Tax ID 482- 0563593
Sold To
CARMEL POLICE DEPARTMENT, CITY CITY OF CARMEL POLICE DEPT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ANN GALLAGHER 317 571 -2720
PO 918953
Carmel, IN 46032 USA
CUSTOI93CrP.0:`� a m�111 V13� FO.B' e: "'TCYTl]S ro rtzs ems.
i
18953 i FEDEX GRND ORIGIN Net 30 Days
4045 1 80161568- LOCKING CLIP SILVER 30 1.500 45.00
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I AST ITEM
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Tracking Numbers: 066443711247887
Subtotal 45.00
Freight 6.24
Sales Tax 0.00
Payment/Credit Amount 0.00
x 'Balance 51.24
I
INDIANA RETAIL TAX EXEMPT PAGE
C i t y of C l armel CERTIFICATE NO.003120155 002 0 1 \11' PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 1 R4 T
ONE 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 PATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
September 25, 008 car seats
SHIP
VENDOR Child Source City of Carmel Police Department
7001 Wooster Pike TO 3 Civic Squarew
Medina, OH 44256 Carmel, IN 4601032
ATTN: Ann Gallagher (317) 571 -2.720
CONFIRMATION =ONIT PAYMENTTERM FREIGHT
QUANTITY DESCRIPTION UNIT PRICE EXTENSION
4 3292198 Express Booster 2pk 30 -100# 51.25 205.00
8 93- 209FSM High Back booster front AD/'2pk 43.95 351.60
6 93 12OFSM Scenera 4 has pos 2pk 39.90 239.40
2 3321198 Evenflo Embrace Infant seat 59.75 119.50
30 4045 8@161568 Locking Clip si ver 1.50 45.00
shipping 133
�s
n
tr Z
4, mo
7
City of Carmel Pa
Send Invoice To:
ATTN; Teresa Anders
3 Civic Square
Carmel, IN $6032
PLEASE INVOICE IN DUPLICATE 1,093.70
DEPARTMENT ACCOUNT PROJECT/ PROJECT ACCOUNT AMOUNT
900 590 -05 car seat ,grant 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. l'
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY l` ��•I. YL/r J/ ��ff fJ �I
SHIPPING LABELS. 1
THIS ORDER ISSUED W COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Ch of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
Q q CLERK TREASURER
DOCUMENT CONTROL NO. A. 4 COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.— T 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
2,0
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. 18953F
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9'/29/08 108443 payment for car seats 1,042.46
9/29/08 108447 payment for locking clips 51.24
Total 1,093./70
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
C hild Source IN SUM OF
7001 Wooster Pike
Mddina, OH 44256
1,093.70
ON ACCOUNT OF APPROPRIATION FOR
police grant -fund
Board Members
Po# INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. a I hereby certify that the attached invoice(s), or
18953F 108443 590 -05 1,042.46 bill(s) is (are) true and correct and that the
18953F 108447 590 -05 51.24 materials or services itemized thereon for
which charge is made were ordered and
received except
October 8 20 08
Signature
chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund