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161310 07/11/2008 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1 ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $832.48 CARMEL, INDIANA 46032 7001 W OH PIKE CHECK NUMBER: 161310 CHECK DATE: 7111/2008 DEPARTMENT ACCOUN PO NUMBER INVOICE NUM BER T AMOUNT DES 852 5023990 16718 100317 331.98 CAR SEATS 900 4359005 16718 100317 500.50 CAR SEATS C� ;i o' use Invoice Invoice Number: 0000100317 7001 Wooster Pike, Medina- OH 44256 Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 6/20/2008 REMITTANCE ADDRESS: invoice Due Date: 7/20/2008 WESTERN' RESERVE DISTRIBUTING INC. f dba CHILD SOURCE Customer: CARMPD P.O. BOX 73714 Sales Order: 0000076987 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 MAGGI Carmel IN 46032 USA Customer P.O. Ship Via F.O.B Terms 16718 FEDEX GRND ORIGIN Net 30 Days I Item Descri Q h Shipp Unit Price Amount i 3702098 TITAN 5 CARSEAT 50# 2PK 2 61.150 122.30 93- 12OFSM +SCENER.A 4 HNS POS (2/PK) 1 6 39.900 239.40 3292198 EXPRESS BOOSTER 2PK 30 -100# 2PK 6 51.250 307.50 93- 299FSM +BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 4 14.750 59.00 LAST ITEM i i I i I i i i i I Tracking Numbers: 066443711101714, 066443711101721, 066443711101738, 066443711101745, 066443711101752, 066443711101769, 066443711101776,066443711101783 Subtotal 728.20 Freight 104.28 Sales Tax 0.00 Payment/Credit Amount 0.00 832.48 Q' INDIANA RETAIL TAX EXEMPT PAGE f Carmel PURCHASE ORD CERTIFICATE N0. 003120155 002 0 ER ER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 1671R 3 ©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 Time I-q. V innS car seat VENDOR Child Source TOIP Our Lady of Mt. Carmel 7001 Wooster Pike 1045 W. 146th Street Medina, OH 44256 Carmel, IN 46032 ATTN: Maggie CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 2' 3702098 Titan 5 Carseat 50# 2pk 61.15 123.50 6 93- 12OFSM Scenera 4Hns Pos 2pk 39.90 239.40 6 3292198 Espress BOoster 30 -100# 2pk 51.25 307.50 4 93- 299FSM Backless Shieldless booster 4pk 14.75 59.00 shipping ®04.28 1,7 590 -05 $500.50 k tic ffi'W,, 852 a $331.98 I A. rr Send Invoice To: City of Carmel Pocesaz' ATTN: Teresa Anders 3 Civic Square f° Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE R32.48 DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT 900 590 •05 car seat fund PAYMENT 852 852 police gtfia fund 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 THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. SHIP REPAID. Ax C.O.D. SHIPMENTS CANNOT BE ACCEPTED. I. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL r y SHIPPING LABELS. THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK- TREASURER DOCUMENT CONTROL NO. 1 6 7 1.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 PO# or INVOICE NO. ACCT #!TITLE AMOUNT pEPT. 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 Child Source Purchase Order No. 16718F L7001 Wooster Pike Terms Medina, OH 44256 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 6/20/08 100317 payment for car seats 832.48 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 832.48 ON ACCOUNT OF APPROPRIATION FOR grant police XWNNYX% fund /police gift fund Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 16718F 100317 590 -05 500.50 bill(s) is (are) true and correct and that the materials or services itemized thereon for 16718F 100317 852 331.98 which charge is made were ordered and received except June 27 2008 4 74 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund