206182 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $950.75
MEDINA OH 44256 CHECK NUMBER: 206182
Yro„ ca
CHECK DATE: 2/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26054 183283 950.75 CAR SEATS
r dfild ss ce' Invoice
Invoice Number: 0000183283
7001 Wooster Pike, Medina, 01 -1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 2/1/2012
REMI TTANCE ADDRESS:
Invoice Due Date: 3/2/2012
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000105491
CLEVELAND, 01 -1 44193
Tax ID ##8 0563593
So To Ship To
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 WEST 146TH STREET
CARMEL, IN 46032 -2584 USA c/o MATTHEW CENTER ATTN MAGGIE
Carmel, IN 46032 USA
ustnmer P..O-- —Sh Via:.
26054 FEDEX GRND ORIGIN Net 30 Days
F Item Descri Qty Shipp Unit Price Amount
ICO34AOB SAFETY Ist DESIGNER CARSEAT 5 -224 W /BASE 6 63.9000 383.40
(NORDICA)
93- 12OFSM SCENERA 4 HNS POS (2 /PK) 6 43.0000 258.00
93-211 FSM VOYAGER HIGHBACK (2 PER PACK) 6 28.9000 173.40
LAST ITEM
i
Tracking Numbers: 066443715408192, 066443715408208, 066443715408215, 066443715408222, 066443715408239, 06644:
Subtotal 814.80
Freight 135.95
Sales Tax 0.00
Payment /Credit Amount 0.00
Bala cn e 950.75
INDIANA RETAIL TAX EXEMPT PAGE
C iIt t CERTIFICATE N0. 003120155 002 0
ty ®1i \��1J lVS rme 1i PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 28A
35- 60000972
ONE 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
DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
9��1092
Child Source Carmel Police Department
VENDOR SHIP 3 CIVIC SgU@FG
Mi Woos4or PING TO Cafmml, IN 46M
Medina, DH 442M (317) 679
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY- I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-C M.05
6 Each Voyager Highback 93- 211FSM $28.90 $173.40
8 Each Scenery 4 HN PO S 93 12OFSM $43.00 $258.00
8 Each Sam 1 st Designer Car Seat ICO34+0.0 $83.90 $383.40
1 Each shipping $135.95 $135.95
0 Sub Total: $950.75
a -4
o e
Send Invoice To:
Carmel Police Depavtmont
Attn: `i'omgz Anderson
3 Civic Squ@m
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. A. C,4 PAYMENT 75
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
i 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
SHIP REPAID.
THIS APPROPRIATION SUFF CIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. l o f P olice
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 2 6 ®5 4 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. NO._
ALLOWED 20
IN THE SUM OF
1
ON ACCOUNT OF APPROPRIATION FOR
h
e
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
02/01/12 183283 car seats $950.75
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
$950.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
26054 I 183283 I 590.05 $950.75 1 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
Friday, February 10, 2012
A
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund