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Home My WebLink About179615 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1 t ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,311.94 CARMEL, INDIANA 46032 7001 WOOSTER PIKE MEDINAOH 44256 CHECK NUMBER: 179615 CHECK DATE: 11/24/2009 DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION 900 4359005 21250 139725 1,311.94 CAR SEATS .r s e s Invoke child source Invoice Number: 0000139725 7001 Wooster Pike, Medina, OH 44256 Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 11/11/2009 REMITTANCE ADDRESS: Invoice Due Date: 12/11/2009 WESTERN RESERVE DISTRIBUTING, INC. dba CHILD SOURCE Customer: CARMPD P.O. BOX 73714 Sales Order: 0000089220 CLEVELAND, OH 44193 Tax ID 482- 0563593 b raS014 T O d °�'v a CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC OLMC 3 CIVIC SQUARE 1045 W 146TH STREET CARMEL, IN 46032 -2584 USA MAGGIE 317 819 -0772 Carmel, IN 46032 USA "Customer.P.O:" a ;M Shi Via�a iF O B a .Terms A 21250 FEDEX GRND ORIGIN Net 30 Days Item xw t; Descrip k Qtv'Shipped TJriLPrieer i Amount 3321198 EVENFLO EMBRACE INFANT SEAT 3 65.800 197.40 93- 12OFSM SCENERA 4 HNS POS (2/PK) 10 43.000 430.00 93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 10 47.200 472.00 93- 299FSM BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 4 14.900: 59.60 LASTITEM I I j i I r Tracking Numbers: 066443711797597, 066443711797603, 066443711797610, 066443711797627, 066443711797634, 066443711797641 ,066443711797658, 066443711797665, 066443711797672 ,066443711797689, 066443711797696, 066443711797702, 066443711797719,066443711797726 MULTIWEIGHT Subtotal 1,159.00 Freight 152.94 Sales Tax 0.00 Payment/Credit Amount 0.00 ®$a1ai1 e 1,311.94 C1 4 INDIANA RETAIL TAX EXEMPT PAGE ty of CERTIFICATE NO. 003120155 002 0 1 -4 1 C PURCHASE ORDER NUMBER Police Department FEDERAL EXCISE TAX EXEMPT 21254 35- 60000972 3 9ft&'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 November 10, 209 car seats J VENDOR Child Source SHIP Trinity Clinic OLMC 7001 Wooster Pike TO 1045 W. 146th Street Medina, OH 44256 Carmel, IN 46032 ATTN: Maggie 317- 819 -0722 CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 3 3321198 Evenflo Embrace infant seats 65.80 197.40 10 93- 120FSM Scemera 4 has pos 4.3.00 430.00 10 93- 209FSM High Back BOoster .front adj 47.20 472.00 4 93- 299FSM Backless Shieldless booster 14.90 59.60 shipping 152.94 v� m City Of Carmel PO Send Invoice To: ATTN: Teresa. Andere 3 Civic Square Carmel, IN 46032 PLEASE INVOICE IN DUPLICATE 1, 311.94 DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT 900 590 -05 car seat grant PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. J• 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 SUFPICIENTTO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY ft 1 rt,i�&" J Y C`'t y t SHIPPING LABELS. f THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2 1- 2 5 CLERK TREASURER DOCUMENT CONTROL NO. A. A COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO._ WARgANT 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 Presctibed 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. 21250F 7001 Wooster Pike Terms Medina, OH 44256 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11/11/0 13 725 a ent for car seats 1,311.94 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 Child Source IN SUM OF 7001 Wooster Pike Medina, OH 44256 1 _311.94 ON ACCOUNT OF APPROPRIATION FOR police grant fund Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 2125OF 139725 590-05 1 4 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 November 18 20 09 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund