178089 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $718.40
MEDINAOH 44256 CHECK NUMBER: 178089
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 136426 718.40 CAR SEAT GRANT FOR CP
child source
Invoice
Invoice Number: 0000136426
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 9/30/2009
REMITTANCE ADDRESS:
Invoice Due Date: 10/30/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000088293
CLEVELAND, OH 44193
Tax ID 482- 0563593
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA ATTN MAGGIE 317 819 -0772
Cannel, IN 46032 USA
Pte¢ x ust
.......erms„
21217 FEDEX GRND ORIGIN Net 30 Days
I
"Descnpk�ori a..= a bs eQty Ship "ped" UnitrP.nce =ti,sAmotiiit r
22- 322LGA SAFETY 1st DESIGNER CARSEAT 5 -224 WBASE 4 63.900 255.60
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 4 47.200 188.80
93- 12OFSM SCENERA 4 HNS POS (2/PK) 4 43,000 172,00
LAST ITEM
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Tracking Numbers: 066443711741262, 066443711741279, 066443711741286, 066443711741293, 06644371 1 741 309,
066443711741316, 066443711741323,066443711741330
Subtotal 616.40
MULTIWEIGHT Freight 102.00
Sales Tax 0.00
Payment/Credit Amount 0.00
1117 s 718.40
INDIANA RETAIL TAX EXEMPT PAGE
C o E' Carmel CERTIFICATE N0. D03120155 002 0 f 1
�.v .u. PURCHASE ORDER NUMBER
Police 'Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 17
3$O 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
September 28 ',009 car seats
VENDOR Child Source SHIP ftfyibf C.AtatIl Police Department
7001 Wooster Pike TO 1045 W. 166th Street
Medina, OH 44256 Carmel, IN 40632
ATTN: Maggie (3170 819 -0772
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
OUANTfTY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
4 22- 3221GA Safety 1st Designer carseat w /base 63.90 255.60
4 93- 209FSM High Back Booster front adj 47.20 188.80
4 93- IOGFSM Scenera 4hns pos 43.00 172.00
shipping 102,00
o
n as
4 ell
g
City of Carmelao c
Send Invoice To: ATTN: Teresa Anders r
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 718.40
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT 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
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.'
G.O.D. SHIPMENTS CANNOT BE ACCEPTED-
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY P� lil.E f l'7'
SHIPPING LABELS. I 1
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chiefu6f FOlice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
e r CLERK TREASURER
DOCUMENT CONTROL NO. r COPY SIGN AND RETURN TO CLERK OFFICE
VIOUCHER NO. WARRANT NO.
ALLOWED 20
N
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
Prescr�ed 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. 21217E
7001 Wooster Pike Terms
medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/30/09 36426 a ent for car seats 718.40
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
VOL)CHER NO. WARRANT NO.
ALLOWED 20
C hild Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
718.40
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
21217F 136426 590 -05 718.40 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
October 7 2 0 09
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund