211680 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $696.40
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 211680
CHECK DATE: 8/1412012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26215 192192 696 .40 CAR SEATS
chit soo e" Invoice
Invoice Number: 0000192192
7001 Wooster Pike, Medina,01-1 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 7/26/2012
REMITTANCE ADDRESS: Invoice Due Date: 8/25/2012
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000109507
CLEVELAND,OH 44193
Tax ID#82-0563593
Sold To . Ship To
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC C/O MATTHEW
3 CIVIC SQUARE 1045 OAKRIDGE RD
CARMEL, IN 46032-2584 USA ATTN MAGGIE MATTHEW 25 CENTER
Cannel, IN 46032 USA
FO�8 ..,..T aj = � —_�_e
26215 FEDEX GRND ORIGIN Net 30 Days
Item , Description: _ Qty_Shipped M Unit Price Amount Y
IC034AOB SAFETY Ist DESIGNER CARSEAT 5-224 W/BASE 4 $ 63.9000 $ 255.60
(NORDICA)
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK $ 47.2000 $ 94.40
3702098 TITAN 5 CARSEAT 50#2PK 4 $ 57.7500 $ 231.00
LAST ITEM
Tracking Numbers: 066443715585084, 066443715585091, 066443715585107, 066443715585114, 066443715585121, 06644:
Subtotal 581.00
Freight 115.40
Sales Tax 0.00
Payment/Credit Amount 0.00
-� - :Balance 696.40
INDIANA RETAIL TAX EXEMPT PAGE
City 6CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT MIS
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.
DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Wi WW a
-a: .r, .... rr-.
tt �:
Child Bourea Ic�;l� k �
ut �: -'-/Ag
VENDOR SHIP�1 ,dfifi ??�': ..
7001 WoostorPiko TO
Modlna, Db 442M
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS t `YrJrj,0 FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account IM .05
1 Each shipping charges . $115.40 $115.40
4 Each Titan 5 Carsaffi 3702098 $57.75 $231.00
2 Each High Back Booster Front Adj 93-2Q9FSM $47.20 $94,40
4 Each Safety 1st Designer Car Seat ;�c.0., �r�r. $63.90 s255.60
3 Sub Total: $596.40
IP
;a �6
D
Send Invoice To:
Comol Pollco Dopmrtmont
Alan:ToFeEm Andorson
CU1Qi, IN 46M. PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. �k6?- PAYMENT .410
'., A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPR Op'TION SUFFI LENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �p I�
SHIPPING LABELS. ChM of Pollco
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE !s
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO- 26215 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
_-_.-- -----_--- —. __
IN THE SUM OF$a
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
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
$696.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26215 192192 -590.05 $696.40
I hereby certify that the attached invoice(s), or
I
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, August 10, 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))
07/26/12 192192 car seats $696.40
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