173764 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
d CHECK AMOUNT: $1,578.70
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDiNA OH 44256 CHECK NUMBER: 173764
CHECK DATE: 6/24/2009
DEPARTMEN ACC P NU MBER INVO N UMBER A DESCR
900 4359005 21004 126971 1,518.70 CAR SEATS
r.
sou rce Invoice
Invoice Number: 0000126971
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 6/1/2009
REMITTANCE ADDRESS: Invoice Due Date: 7/1/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 000008531.1
CLEVELAND, OH 44193
Tax ID 482- 0563593
Sold To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT, CITY
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA ANN GALLAGHER 317 -571 -2720
CARMEL, IN 46032 -2584 USA
Customer "PO. Ship Via, s F.'O:B I t Terrri
j
21004 LTL VITRAN ORIGIN Net 30 Days
Descrip FQ ty r Shi l?Ped Unit.Price Amount
22 322LGA SAFETY I st DESIGNER CARSEAT 5 -22# W /BASE 5 63.900 319.50
93- 12OFSM SCENERA 414NS POS (21PK) 10 43.000 430.00
93- 209FSM I HIGH BACK BOOSTER FRONT ADJ 2PK 6 47.200 283.20
93- 211FSM VOYAGER HIGHBACK (2 PER PACK) 4 29.400 119.60
22- 077FSM ON BOARD INFANT CAR SEAT 1 103.000 103.00
22- 53OFSM APEX 65 BOOSTER SEAT 5 PT HNS 1 111.400 111.40
I
LAST ITEM
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Tracking Numbers: 00354792574
Subtotal 1,366.70
lift gate and inside delivery Freight 152.00
Sales Tax 0.00
Payment/Credit Amount 0.00
ff
21,1 1 ®Balance 1,518.70
0 INDIANA RETAIL TAX EXEMPT PAGE
it o I' Carmel PURCHASE OR CERTIFICATE NO. 003120155 002 0 1 "b j
y �Y 1i DER NUMBER
.I
Police ,Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 7-100
3 0 CIVIC 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
Mav 29. 2009 t :L ear 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 Gallabber 327- 571 -2720
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
5 22- 322LGA Safety 1st Designer Carseats 5 -22# W /base 63.90 319.50
10 93- 12OFSM Scenera 4 HNS POS (2pk) 43.00 430.00
6 93 209FSM High Back Booster Front adj 2pk 47.20 283.20
4 93-- 211FSM Voyager Highback (2 per pack) 29.90 119.60
1 22- 077FSM ON Board Infant Carseaft 103.00
1 22-- 53OFSH APEX 65 Booster s4 t H 111.40
shipping 152.00
14
a �f.:
City of Carmel Po y kt
Send Invoice To: ATTN: Teresa Andersb
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 1,518.70
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
900 590 -05 car seat grant PAYMENT
AP 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 UNOBLIGATFD BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. 1
ORDERED BY A ll I Z, f
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO,
10 0 CLERK-TREASURER
DOCUMENT CONTROL NO. 2 A.A. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER 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
t
Title
Cost distribution ledger classification if
claim }paid motor vehicle highway fund
Prescibed 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
C hild Source Purchase Order No. 21004F
7 001 Wooster Pike Terms
M edina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/1/09 126971 pyament for carseats 1,518.70
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
1,518.70
ON ACCOUNT OF APPROPRIATION FOR
police grant fund
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
0 11518 7 0 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
June 16 2 0 09
&�4� b �4
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund