HomeMy WebLinkAbout209097 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,383.15
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 209097
CHECK DATE: 5/2212012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26160 188152 1,383.15 CAR SEATS
chile! s r Inv ®ice
Invoice Number: 0000188152
7001 Wooster Pike, Medina, OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 5/14/2012
REMITTANCE ADDRESS: Invoice Due Date: 6/13/2012
WESTERN RESERVE DISTRIBUTING. INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000107726
CLEVELAND, OH 44193
Tax ID #82- 0563593
Sold To' Slip To
s
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL, IN 46032 -2584 USA C/O MATTHEW 25 CENTER
Carmel, IN 46032 USA
TRINITY CLINIC FEDEX GRND ORIGIN Net 30 Days
ICO34AOB SAFETY 1st DESIGNER CARSEAT 5 -224 W /BASE 8 63.9000 511.20
(NORDICA)
93- 209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 10 47.2000 472.00
3702098 TITAN 5 CARSEAT 50# 2PK 4 57.7500 231.00
LAST ITEM
Tracking Numbers: 066443715509615, 066443715509622, 066443715509639, 066443715509646, 066443715509653, 06644:
Subtotal 1,214.20
Freight 168.95
Sales Tax 0.00
Payment/Credit Amount 0.00
Balance 1,383.15
w INDIANA RETAIL TAX EXEMPT PAGE
C Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 28
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
0=12
Child Sourco C@rnel Police Dopy went
VENDOR SHIP 9 CIVI Squm
7001 Wooster Pike TO Cumai, IN 46
Modin@, 011 442M (317) 571 9
CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT
QUANTITY
UNIITOF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 0 0-M.05
9 Each shipping $188.95 $1168.95
4 Each Titan 5 Carseat 3702098 $57.73 $231.00
10 Each High Back Booster (Front Adj 93-209 $47.20 $472.00
8 Each Safety 1st Designer Car Seat Id Ow 5�7 $83.90 $511.20
Sub Total: $1,383.15
P v
NE ti���� mar "f
Send Invoice To:��
1
Carnol Police DopaAmGnt
Attn: Toros@ Anderson
3 C IVIC Squam
CwmGI, IN 460 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. Q3 PAYMENT $1,383.15
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
SHIP REPAID.
THIS APPROPRIATION SUFF IENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE r 0
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK -TREASURER
DOCUMENT CONTROL NO. 2 6 1 6
A.P.V. COPY -SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.---- WARRANT
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
(D
Board Members
or INVOICE NO. ACCT #/TITLE AMOUNT
D 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF
7001 Wooster Pike
Medina, OH 44256
$1,383.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
26160 I 188152 I 590.05 I $1,383.15 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, May 18, 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))
05/14/12 188152 car seats $1,383.15
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