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Home My WebLink About178089 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: $718.40 MEDINAOH 44256 CHECK NUMBER: 178089 CHECK DATE: 10/14/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 900 4359005 136426 718.40 CAR SEAT GRANT FOR CP child source Invoice Invoice Number: 0000136426 7001 Wooster Pike, Medina, OH 44256 Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 9/30/2009 REMITTANCE ADDRESS: Invoice Due Date: 10/30/2009 WESTERN RESERVE DISTRIBUTING, INC. dba CHILD SOURCE Customer: CARMPD P.O. BOX 73714 Sales Order: 0000088293 CLEVELAND, OH 44193 Tax ID 482- 0563593 CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC 3 CIVIC SQUARE 1045 W 146TH STREET CARMEL, IN 46032 -2584 USA ATTN MAGGIE 317 819 -0772 Cannel, IN 46032 USA Pte¢ x ust .......erms„ 21217 FEDEX GRND ORIGIN Net 30 Days I "Descnpk�ori a..= a bs eQty Ship "ped" UnitrP.nce =ti,sAmotiiit r 22- 322LGA SAFETY 1st DESIGNER CARSEAT 5 -224 WBASE 4 63.900 255.60 93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 4 47.200 188.80 93- 12OFSM SCENERA 4 HNS POS (2/PK) 4 43,000 172,00 LAST ITEM i i i i i i i i i i i Tracking Numbers: 066443711741262, 066443711741279, 066443711741286, 066443711741293, 06644371 1 741 309, 066443711741316, 066443711741323,066443711741330 Subtotal 616.40 MULTIWEIGHT Freight 102.00 Sales Tax 0.00 Payment/Credit Amount 0.00 1117 s 718.40 INDIANA RETAIL TAX EXEMPT PAGE C o E' Carmel CERTIFICATE N0. D03120155 002 0 f 1 �.v .u. PURCHASE ORDER NUMBER Police 'Department FEDERAL EXCISE TAX EXEMPT 35- 60000972 17 3$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