207002 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CHECK AMOUNT: $1,982.90
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 207002
CHECK DATE: 3/13/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26074 184613 1,982.90 CAR SEATS
s ;te Invo
Invoice Number: 0000184613
7001 Wooster Pike. Medina, 01 -1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 2/27/2012
REMITTANCE ADDRESS: Invoice Due Date: 3/28/2012
WESTERN RESERVE DISTRIBUTING, INC. Customer: CARMPD
dba CHILD SOURCE
P.O. BOX 73714 Sales Order: 0000106070
CLEVELAND. 01 1 44193
Tax ID 982- 0563593
Ship To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032 -2584 USA CALL FOR APPT 317 -571 -2720
Carmel, IN 46032 USA
Cust Ship Via
26074 L "I'L VITRAN ORIGIN Net 30 Days
Qt� Shlpped Pn A mount. _1
ICO34AOB m SAFETY Ist DESIGNER CARSEAT 5 -224 W /BASE 10 63.9000 T 639.00
(NORDICA)
93- 12OFSM SCENERA 4 HNS POS (2 /1 10 43.0000 430.00
93 -21 1 FSM VOYAGER HIGHBACK (2 PER PACK) 8 S 29.9000 239
BC049FSM Belt Positioning Apex65 l I 1 1.4 ?()0 1 1 1.40
93- 209FSM HIGH BACK BOOSTER FRONT AD.i 2PK 6 47.2000 283.20
93- 299FSM BACKLESS SHIELDLESS BOOSTER (4 PER. PACK) 4 14.9000 59.60
LAST ITEM
Tracking Numbers: 00471741033
LIFT GATE/INSIDE CALL 317-571-2720 Subtotal 1,762.40 Freil;ht 220.50
Sales Tax 0.00
Pavment /Credit Amount 0.00
1' ,Balance T 1.982.90
Cit of
C����� INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO. 003120155 002 0
PURCHASE ORDER NUMBER
z
FEDERAL EXCISE TAX EXEMPT 20074
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
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Child Sour+eo Carmel Police Dap @ArnoM
VENDOR SHIP 3 Civic Rqu
7001 Roster PIko TO emmol, IN 4=
MGdlna, Oil 442M (W) 671 a269
CONFIRMATION BLANKET I CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account oaz1a.03
1 Each shipping cha rges $220.50 $220.50
1 Each Beft Positioning Apelt85 0004OFSM $191.40 $191 .40
4 Each Baeldess Shleldless Booster 93 F $14.90 $50.60
6 Each nigh Back Booster Front Adj r i en d9 $47. $283.20
8 Each Voymger Highbec 3 1 e $20.00 $230.20
10 Each Sconera 4 HN POS s? C
v� q .1�3�•120 e $43.00 $430.00
10 Each SoMy 9st Desig Car So,`" �„•axi ICO34AOB b
$63.10 $639.00
9
�t Sob 'dotal: $1,982.90
f
Al
1,1
V
'`I A i
Send Invoice To:
C @rmol Police Dop2ftont
Attn: Terosm Anderson
3 Civic Squm
C@rmGl, IN 41 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT 1,982 90
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 CE TIFY THATTHERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APP ON SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.Q.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �w
SHIPPING LABELS. Cl9ie� of I �y
�olll±r�
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 0 7 4 A.P .v. 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 INvbiCE NO. ACCT /TITI -E 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 leciger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
$1,982.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members
26074 I 184613 590.05 I $1 1 hereby certify that the attached invoice(s), or
bills) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, March 09, 2012
Chief of Police
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))
02/27/12 184613 car seats $1,982.90
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
2a
Clerk- Treasurer