177148 09/16/2009 CITY OF CARMEN, INDIANA VENDOR: 361470 Page 1 of 1
t' ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,115.80
r; CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 177148
CHECK DATE: 911512009
DEPA ACCOUNT PO NUMB INV OICE NUMBER AMOUNT DESCRIPTION
852 5023990 21090 133561 1.5.80 CAR SEATS
900 4359005 21090 133561 1,100.00 CAR SEATS
T
C�Iild source- �r1VU1Ce
Invoice Number: 0000133561
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 8/27/2009
REMITTANCE ADDRESS: Invoice Due Date: 9/26/2009
WESTERN RESERVE DISTRIBUTING, INC.
r
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000087423
CLEVELAND, OH 44193
Tax ID #82 -0563593
S}tipTo „'tt
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT, CITY
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA CARMEL, IN 46032 -2584 USA
GUStOmer P, O "hli] Vla G, F.O.B. r a TCTTt1S Z
i
21090 FEDEX GRND ORIGIN Net 30 Days
Item, Descii t5 hipped, UntxPrice`Ainount,.
22 -322LGA SAFETY 1st DESIGNER CARSEAT 5 -229 WBASE 7 i 63.900 447.30
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 47.200 377.60
2794198 BIG KID NO BACK BOOSTER 40 -100# 4 17.500 70.00
93- 12OFSM SCENERA 4 HNS POS (2/PK) 2 43.000 86.00
LAST ITEM
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Tracking Numbers: 066443711689472 066443711689489, 066443711689496, 066443711689502, 066443711689519,
066443711689526 06644 3 7 11689533, 066443711689540,066443711689557 ,066443711689564,
066443711689571, 066443711689588,066443711689595
Subtotal 980.90
Freight 134.90
Sales Tax 0.00
Payment/Credit Amount 0.00
Balance 1 115.80
INDIANA RETAIL TAX EXEMPT PAGE
C i t y of C CERTIFICATE NO.003120155 d02 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 2in
339NMCIVIC 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
u¢iaat 75 2 o car seats
VENDOR Child. Source SHIP City of Carmel Police Department
7001 Wooster Pike TO 3 Civic Square
Medina, OH 44256 Carmel, IN 46032
ATTN: Ann Gallagher
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
IRuo 187363
7 22- 322LGA Safety let Designer carseat 5 -22# w /base 63.90 447.30
8 93- 209FSM High Back Booster front ad3 2pk 47.20 377.60
14 2794198 Big Rid no back boaster 0- 0# 17.50 770.00
2 931290'M Scenera 4 has os 43.00 86 >00
shipping p 134.90
of y
852 15.80
590 -05 $1
t
City of Carmel Pali? t fL
Send Invoice To: ATTN: Teresa Ande "t
3 Civic Square
Carmel, IN 46033
PLEASE INVOICE IN DUPLICATE 1,115.80
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
900 590 -05 car seat grant P AYMENT
852 852 police gift fund AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
J VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
ANDACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
21 LERK- TREASURER
P•
DOCUMENT CONTROL NO. A. RV COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO..____-
AL-L.OWED 20
IN THE SUM OF a
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# INVQICE NO. ACCT #/TITLE AMOUNT
DEFT. 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. 3995)
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. 2109OF
7001 Wooster Pike Terms
Medina, OH' 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/27/09 133561 payment for car seats 1,115.80
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;115.80
ON ACCOUNT OF APPROPRIATION FOR
nnl lme grant fitnfl
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
2109OF 133561 852 15.80 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
2109OF 133561 590 -05 i ,100.00 which charge is made were ordered and
received except
September 2 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund