162683 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
CHILD SOURCE ONE CIVIC SQUARE
r, CHECK AMOUNT: $1,672.75
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 162683
CHECK DATE: 8/20/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 18926 104107 1,672.75 CAR SEATS
child sour+cLnr Invoice
Invoice Number: 0000104107
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 8/6/2008
REMITTANCE ADDRESS: Invoice Due Date: 9/5/2008
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000078417
CLEVELAND, OH 44193
Tax ID 482- 0563593
'Sold To Ship To
CARMEL POLICE DEPARTMENT, CITY OUR LADY OF MT CARMEL
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA ATTN MAGGIE
Carmel, IN 46032 USA
Customer P.O.. Shi Via �F,O.B_ -_Terms_ a
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18926. LTL ESTES ORIGIN Net 30 Days
Item Descri Q ty Shipped Unit Price Amount
3021198 DISCOVERY INFANT SEAT 10 j 44.050 440.50
93- 12OFSM SCENERA 4 HNS POS (2/PK)
10 39.900 399.00
3292198 EXPRESS BOOSTER 2PK 30 -100# 2PK 10 51.250 j 512.50
93- 299FSM BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 12 14.750 177.00
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LAST ITEM
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Tracking Numbers: 155 0925158
Subtotal 1,529.00
Freight 143.75
Sales Tax 0.00
Payment/Credit Amount 0.00
_Balance 1,672.75
Ci INDIANA RETAIL TAX EXEMPT PAGE
ty.,of C armel PURCHASE ORDER CERTIFICATE NO. 003120155 042 0 D -N NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 ISQ9
3 p- UE {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
Augu r PAPatR
SHIP
VENDOR Child Source To (3}yL�dl*Cguu,= true,t
1 7001 Wooster Pike 3091vr[c 146th Street
Medina, OH 44256 Carmel, IN 46032
ATTN: Maggie
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
10 3021198 Discovery Infant Seats 44.05 440.50
10 93- 12OFSM Scenera 4 Hns Pas (2PK) 39,90 399.00
10 3292198 Express Booster 2PK 30 -1001 51.25 512.50
12 93- 299FSM Backless Shieldless Boaster (4pkj 14.75 177.00
slipping 143.75
v a
e
p•
Cityoof Carmel Pot 'e'� 3 r jw
Send Invoice To: 4
ATTN: Teresa Anderso
3 Civic Oquare
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 1,672,75
DEPARTMENT ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
900 590 car seat gran 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 APTACHED.
APPROPRI a5
SHIPPING INSTRUCTIONS I HEREBY CERTIFY H� IS AN U l±IGATED BALANCE IN
SHIP REPAID.,
THIS A ON SUFFICIENT T -PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED,
ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Ch I f of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
I 1 9A CLERK- TREASURER
DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE
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VOUCHER NO. WARRANT NO.
ALLOWED 20
i 1
IN THE SUM OF
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ON ACCOUNT OF APPROPRIATION FOR
j
Board Members
PO# or INVOICE NO. ACCT #RITLE 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
'I
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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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. 18926F
7001 Wooster Pike, Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
816/08 104107 payment for car seats 1,672.75
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
1,672.75
ON ACCOUNT OF APPROPRIATION FOR
police grants fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
18926F 104107 590 -05 1,672.75 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 13 20 08
Signature
Chief of P01ice
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund