170342 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
0 ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,381.80
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINAOH 44256 CHECK NUMBER: 170342
CHECK DATE: 4/1/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 20077 120511 1,381.80 CAR SEATS
child source Invoice
Invoice Number: 0000120511
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 3/11/2009
REMITTANCE ADDRESS: Invoice Due Date: 4/10/2009
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000083349
CLEVELAND, OH 44193
Tax ID 482- 0563593
S 'Id TO S1iip To pe ate a
CARMEL POLICE DEPARTMENT, CITY OUR LADY OF MT CARMEL
3 CIVIC SQUARE 1045 W 146TH STREET
CARMEL, IN 46032 -2584 USA ATTN MAGGIE 317- 81.9 -0772
Carmel, IN 46032 USA
Customer P.O:: Ship ':V�a al F.O B„ f Terms
a ��n
20077 FEDEX GRND ORIGIN Net 30 Days
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se
Dert P I1, a a n -ter17] Uf11tPr1Ce rem Amount
Q hPP
93- 12OFSM SCEN'ERA 4 HNS POS (2/PK) 14 43.000 602.00
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 6 47.200 283.20
93- 299FSM BACKLESS SHIELDLESS BOOSTER (4 PER PACK) 4 14.900 59.60
3321198 EVENFLO EMBRACE INFANT SEAT 4 65.800 263.20
LAST ITEM
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I
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Tracking Numbers: 06644371 1 451 987, 066443711451994, 066443711452007, 066443711452014, 066443711452021,
066443711452038, 066443711452045, 066443711452052,066443711452069 ,066443711452076,
066443711452083, 066443711452090, 066443711452106, 066443711452113,066443711452120
MULTI WEIGHT Subtotal 1,208.00
Freight 173.80
Sales Tax 0.00
Payment/Credit Amount 0.00
7,°�Balance 1
INDIANA RETAIL TAX EXEMPT PAGE
C o II C rme CERTIFICATE NO.003124155 402 0 1 of 1
q1' 11 CuL `L JL PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 20077
310f� CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AI
P
CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPdNDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CAR MEL 1997
PURCHASE ORDER DATE I DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
March 10, 2009 car seats
VENDOR Child Source SHIP Our Lady of Mt. Carmel
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
14 93- 120FSM Seenera 4 tins Pos car seats 43.00 602.00
6 93- 209FSM High back booster front Adj car seats 47.20 283.20
4 93- 299FSM Backless Shieldless booster car seats 14.90 59.60
4 3321198 Evenflo Embrace infant car seats 65.80 263.2q
shipping 173.80
v
l
City f Carmel Po
Send Invoice To: Y C''m
ATTN: Teresa Anderso
3 Civic Xquare w_
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 1,381
DEPARTMENT ACCOUNT T PROJECT PROJECTACCOUNT AMOUNT
900 590 -05 car seats 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
f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS T I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATIONS rFF�TOPAY THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. j
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE ASsiyant Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO
2 0 CLERK- TREASURER
DOCUMENT CONTROL NO. A.P. COPY- SIGN AND RETURN T CLERK OFFICE
VOt)CHER NO._— WARRANT NO.__
ALLOWED 20
T 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. 20077F
7001 Wooster Pike Terms
Medina, OH 44255 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11 a ent for car seats 1,381.80
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
C hild Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
1,381.80
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
20077P 120511 590 -05 1,381.80 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
March 25 20 09
*,�4� b,
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund