179615 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
t ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,311.94
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINAOH 44256 CHECK NUMBER: 179615
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION
900 4359005 21250 139725 1,311.94 CAR SEATS
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s Invoke
child source
Invoice Number: 0000139725
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 11/11/2009
REMITTANCE ADDRESS: Invoice Due Date: 12/11/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000089220
CLEVELAND, OH 44193
Tax ID 482- 0563593
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raS014 T O d °�'v a
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC OLMC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA MAGGIE 317 819 -0772
Carmel, IN 46032 USA
"Customer.P.O:" a ;M Shi Via�a iF O B a .Terms A
21250 FEDEX GRND ORIGIN Net 30 Days
Item xw t; Descrip k Qtv'Shipped TJriLPrieer i Amount
3321198 EVENFLO EMBRACE INFANT SEAT 3 65.800 197.40
93- 12OFSM SCENERA 4 HNS POS (2/PK) 10 43.000 430.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 10 47.200 472.00
93- 299FSM BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 4 14.900: 59.60
LASTITEM
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Tracking Numbers: 066443711797597, 066443711797603, 066443711797610, 066443711797627, 066443711797634,
066443711797641 ,066443711797658, 066443711797665, 066443711797672 ,066443711797689,
066443711797696, 066443711797702, 066443711797719,066443711797726
MULTIWEIGHT Subtotal 1,159.00
Freight 152.94
Sales Tax 0.00
Payment/Credit Amount 0.00
®$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
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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