176706 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $669.85
s z CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 14256 CHECK NUMBER: 176706
CHECK DATE: 9/2/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D ESCRIPTION
900 4359005 21059 132706 669.85 CAR SEATS
ch,c�d source Invoice
Invoice Number: 0000132706
7001 Wooster Pike, Medina, ON 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 8/18/2009
REMITTANCE ADDRESS: Invoice Due Date: 9/17/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000087184
CLEVELAND, ON 44193
Tax ID 482- 0563593
4r ...row a E
solaTar ,�sb�P�To a,� �.��t��. �,v.
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 W 146TH STREET
TERESA ANDERSON ATTN: MAGGIE 317 819 0772
CARMEL, IN 46032 -2584 USA Carmel, IN 46032 USA
7� e,4sto ner P.O.
21059 FEDEX GRND ORIGIN Net 30 Days
Item_ rt :Descri �w 4 ',Q t} „Shi pAe'd 'Unit Pricer i Amaun
t, r:
3321198 EVENFLO EMBRACE INFANT 5800
NT SEAT 6
394.80
93- 12OFSM SCENERA4 HNS POS (2/PK) 2 43.000 86.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 2 47.200 94.40
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LAST ITEM
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Tracking Numbers: 066443711674096, 066443711674102, 066443711674119, 066443711674126, 06644371 1 6741 33,
066443711674140, 066443711674157,066443711674164
Subtotal 575.20
Freight 94.65
Sales Tax 0.00
Payment/Credit Amount 0.00
:_Balance 669.85
City. INDIANA RETAIL TAX EXEMPT PAGE
of C armel CERTIFICATE NO. 003120155 002 0 1 Of 1
PURCHASE ORDER NUMBER
i Police 'department FEDERAL EXCISE TAX EXEMPT
35- 60000972 21059
31DNE CIVIC SQUARE THIS NU Ai
MBER MUST APPEAR ON INVOICES, 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
.kuRust 14, 2009 car seats
VENDOR Child Source SHIP Trinity Clinic
7001 Wooster Pike TO 1045 W. 146th Street
Medina, OH 44256 Carmel, IN 46032
ATTN: Maggie 317 -819 -0772
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Quote #87160
6 ea Evenflo Embrace Infant seat 3321198 65480 340480
2 ea Scenera 4 Hns Pos (2pk) 93- 120FSM 43.00 86.00
2 ea High back booster front a j 2pk) 93- 209FSM 47420 94.40
shipping jf. 94.65
ea t
TT
Send Invoice To: City of Carmel Pol '�tN
ATTN: Teresa. Analeesoao� f
3 Civic Square
Carmel., IN 46032
PLEASE INVOICE IN DUPLICATE 669.85
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT 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.,
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
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
0 CLERK-TREASURER
DOCUMENT CONTROL NO.
A:P. COPY SIGN AND RETURN TO CLERIC'S OFFICE
VdLICHER NO. WARRANT 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
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
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. 21 059F
7001 Wooster Pike Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/18/09 132706 payment for car seats 669.85
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
669.85
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
21059F 132706 590 05 669.85 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
August 24 20 09
&�A�-
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund