207781 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
s ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $1,049.90
MEDINA OH 44256
CHECK NUMBER: 207781
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26098 185416 1,049.90 CARSEATS
Child source Invoice
19 9 Invoice Number: 0000185416
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 3 /21/2012
REMITTANCE ADDRESS: Invoice Due Date: 4/20/2012
WESTERN RESERVE DISTRIBUTING, INC.
d Customer: CARMPD
ba CHILD SOURCE
P.O. BOX 73714 Sales Order: 0000106534
CLEVELAND, OH 44193
Tax ID #82- 0563593
.;Sold Slip To s i
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC��
3 CIVIC SQUARE 1045 OAKRIDGE RD
CARMEL, IN 46032 -2584 USA C/O MATTHEW 25 CENTER
Carmel, IN 46032 USA
B Y
26096 FEDEX GRND ORIGIN Net 30 Days
r
Amount
ICO34AOB SAFETY 1st DESIGNER CARSEAT 5 -22# W /BASE 6 63.900E 383.40
(NORDIC.A)
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 6 472000 S 283.20
3702098 TITAN 5 CARSEAT 50# 2PK 4 61.1500 244.60
LASTITEM
Tracking Numbers: 066443715453956, 066443715453963, 066443715453970, 066443715453987, 066443715453994, 06644;
Subtotal 911.20
Freight 138.70
Sales Tax 0.00
Payment/Credit Amount 0.00
1 Bala e 1,049.90
INDIANA RETAIL TAX EXEMPT PAGE
C f C arme l CERTIFICATE NO. 003120155 002 0 �1 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Child Source Carmel Police Dopartmont
VENDOR SHIP 3 Civic Squm
701 Woostor Pike TO Carmol, IN 48032
Molina, ON 44MB 671.2
CONFIRMATION BLANKET I CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00$90.15
9 Each shipping charges $138.70 $138.70
4 Each Titan 5 Calrseat 3702098. $61.15 $244.60
6 Each high Bads Boaster Front Adj 93- 209FSM $47.20 $283.20
6 Each Safety 1st Designer Car Seat {CO $63.90 $383.40
Sub Total: $1,049.90
pjk
is
if
Send Invoice To:
Carmel Police Dopadtnient
Attn: Teream Andmon
3 Civic Squm
Cannol, IN 48 a PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT F AMOUNT
Carmel Police Dept. /"��3 PAYMENT si'mm
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
,j NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIvir�H
PRIAT TTHERE IS'AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPRO N SUFFICIENT .O'PAY FOR THE ABOVE ORDER. x
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. IoQ of pollee
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 ®9 8
A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER N{).— WARRANT NO`____
ALLOWED 20___
|N THE SUM OFS
ON ACCOUNT OF APPROPRIATION FOR
c�
Board Members
PO# or hereby certify that the attached invoiue(a)'or
bill(s) is (are) true and correct and that the
materials nr services itemized thereon for
which charge ia made were ordered and
received except
20____
Signature
Tioo
Cost momuuhvn ledger classification if
clam 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))
03/21/12 185416 car seats $1,049.90
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
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
$1,049.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
26098 I 185416 I 590.05 I $1,049.90 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
Tuesday, March 27, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund