173263 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $394.23
MEDINAOH 44256
CHECK NUMBER: 173263
CHECK DATE: 611012009
DE PARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER A DESCRIPTION
852 5023990 20988 125967 394.23 CAR. SEATS
irasource- Invoice
3116161-4-3 1 Invoice Number: 0000125967
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 5/19/2009
REMITTANCE ADDRESS: Invoice Due Date: 6/18/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 000008501.4
CLEVELAND, OH 44193
Tax ID #82- 0563593
Slug To
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CARMEL POLICE DEPARTMENT, CITY OUR LADY OF MOUNT CARMEL
3 CIVIC SQUARE TRINITY CLINIC
CARMEL, IN 46032 -2584 USA 1045 W 146TH STEET
MAGGIE 317 819 -0772
Carmel, IN 46032 USA
Customer P.O:... o 5h�p Via, r'�; i�� s �y>~ A.B ,Terms
I
20988 FEDEX GRND DESTINATION Net 30 Days
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lfem a T,;�, Descrip Q t5';Ship ped u,Uriit Pnce A,inount j
3321198 EVENFLO EMBRACE INFANT SEAT 3 65.800 197.40
93- 21IFSM VOYAGER HIGHBACK (2 PER PACK) 4 29.900 119.60
01938CSF SPRINT TRAVEL SYSTEM (CIRCLE SAFARI) 1 117.850 117.85
LAST ITEM
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Tracking Numbers: 066443711547062, 066443711547079, 066443711547086, 066443711547093, 066443711547109
066443711547116
Subtotal 434.85
Freight 77.23
Sales Tax 0.00
Payment/Credit Amount 0.00
Bal'arice 512.08
3 7819
ANN GALLAGHER
171 PARKVIEW CT PH.844 -5975 2f�704312740
CARMEL. IN 48032
S FIAT F. 1 /7
DLR OF (J
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M &I MARSHALL ILSLEY BANK
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INDIANA RETAIL TAX EXEMPT PAGE
Ci 1i ���J la,. mo a� el CERTIFICATE NO. 003120155 002 0 !i PURCHASE ORDER NUMBER
Police Aepartnent FEDERAL EXCISE TAX EXEMPT
35- 60000972 O9R
3(1�NEZCIVIC 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
Ma, v 19 Q ar seats
VENDOR Child Source_ SHIP Trinity Clinic
7002 Wooster Pike TO Our bade of Mount Carmel
Medina, OH 44256 1045 W. 146th Street
Carmel., IN 46032
C
NFIRMATION BLANKET CONTRACT PAYMENTTERMS I=N: Maggie 317 -8F;2 G
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
3 Evenflo Embrace Infant seats 33219 65.80 197.40
4 FSM Cosco Voyager (2 per carton) 93- 211FSII 2990 119.60
1 Cosco Beginning Sprint Travel systemll IY$$38CFS 117,85
shipping 77.23
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Send Invoice To:
City of Carmel Po z I
ATTN: Teresa Andersa�j
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 512.08
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
852 852 police gift ffiffind 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. r
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY .f A •p
SHIPPING LABELS. 1
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Po
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. L AP. 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
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. 20988F
7001 Wooster Plke Terms
Medina, OH 44256 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/19/09 125967 a ent for car seats 512.08
5/22/09 less payment from A. Gallagher 117.85
Total 394.23
1 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
394.23
ON ACCOUNT OF APPROPRIATION FOR
police gift fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
20988F 125967 852 394.23 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 2 2009
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund