212542 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $2,235.42
+� MEDINA OH 44256
,o. CHECK NUMBER: 212542
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 26230 193503 1, 503 .32 CAR SEATS
900 4359005 26231 193504 732 . 10 CAR SEATS
�„d rce- Invoice
lignommmiam Invoice Number: 0000193503
7001 Wooster Pike.Medina,OH 44256
Ph:330.723.4739 Fax: 330.72 1.6799 Invoice Date: 8/17/2012
REMITTANCE ADDRESS: Invoice Due Date: 9/16/2012
WESTERN RESERVE DISTRIBUTING, INC.
Customer: CARMPD
dba CHILD SOURCE
P.O. BOX 73714 Sales Order: 00001 10332
CLEVELAND,OH 44193
Tax ID#82-0563593
Sold To - Ship To _
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032-2584 USA 317-571-2559
Carmel, IN 46032 USA
Customer P:O
Sfii- V►a -- _ -
-_ _.. . .,., . -: _. .,1 O:B __ Terms
26230 FEDEX GRND ORIGIN Net 30 Days
L Item Descripton m h►pped Unit Price Amount
IC034AOB SAETY
Ist DESIGNER CARSEAT 5-22# W/BASE 9 S 63.9000 + 575.10
(NORDICA)
3702098 TITAN 5 CARSEAT 50H 2PK 8 $ 57.7500 S 462.00
93-211 FSM VOYAGER HIGHBACK (2 PER PACK) 6 $ 29.9000 S 179.40
3701 198 TITAN 5 CARSEAT 504 1 PK 1 S 57.7500 S 57.75
LAST ITEM
i
Tracking Numbers: 066443715610304, 06644371 561 031 1, 066443715610328, 066443715610335, 066443715610342, 06644:
Subtotal 1,274.25
Freight 229.07
Sales Tax 0.00
Payment/Credit Amount 0.00
(' ____Balance 1,503.32
ciild u e' Invoice
Invoice Number: 0000193504
7001 Wooster Pike,Medina,OH 44256
Ph: 330.723.4739 Fax: 330.721.6799 Invoice Date: 8/17/2012
REMITTANCE ADDRESS: Invoice Due Date: 9/16/2012
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 00001 10336
CLEVELAND,OH 44193
Tax ID#82-0563593
Sold To ,, Ship To
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE RD
CARMEL, IN 46032-2584 USA ATTN MATTHEW 25 CENTER
MAGGIE
Carmel, IN 46032 USA
Customer-P.O Shi Via F.013.. - -- fermc _ A
26231 FEDEX GRND ORIGIN Net 30 Days
Item Description�_A_ __ Qty_Sh�pped Unit Price _ Amount
IC034AOB _ TSAFETY Ist DESIGNER CARSEAT 5-22# W/BASE 4 $ 63.9000 $ 255.60
(NORDICA)
3702098 TITAN 5 CARSEAT 50#2PK 4 $ 57.7500 $ 231.00
93-211 FSM VOYAGER HIGHBACK (2 PER PACK) 4 $ 29.9000 $ 119.60
LAST ITEM
i
Tracking Numbers: 066443715610472, 066443715610489, 066443715610496, 066443715610502, 066443715610519, 06644;
Subtotal 606.20
Freight 125.90
Sales Tax 0.00
Payment/Credit Amount 0.00
.-____:Balance 732.10
INDIANA RETAIL TAX EXEMPT PAGE
City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 2634
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
0/4562092 ,f
Child Soums � e " i J
SH
s C /
VENDOR TOIP ��
7004 Woostor Piko
Modina, 0I4 44255
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS - -) CF,41W
V�
Account �pp,pUNIITOF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account IH .05
4 Each !Voyager High5ack 93-211FSM $29.90 $119.60
4 Each Titan 5 Carsed 3702096 $57.75 $ I.%
4 Each Safety 9si Designer Car Seat 'jC0'fI, $63.90 $235.60
1 Each shipping charges ', $125.90 $125.90
Sub Total: $732.10
I g -9
qu4 3
x
Send Invoice To: r � )
C@101 Police Dop.,21tMont
Attn:Torasa Andorcon
3 CIVIC aqumm
Carml, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $732.40
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION S�T TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. ,erg
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE hie oY/p
Folk's
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
q CLERK-TREASURER
DOCUMENT CONTROL NO. "••+� A.P.V. COPY-SIGN,AND RETURN TO CLERK'S OFFICE
VOUCHER VVARRANTND`____
ALLOWED 20___
|N THE SUM DF$ '
[ `
ON ACCOUNT OF APPROPRIATION FOR
�
�
Board Members
PO#or
DEPT# INVOICE NO. ACCT#iTITLE AMOUNT | hereby certify that the attached invoice(s), or
bill(s) is (sxa) true and correct and that the
materials or services itemized thereon for
which charge ie made were ordered and
received except
'
` 20___.
'
Signature �
' Title
Cost distribution leugencmaomraxnn if ,
claim paid mnm,vehicle highway fund .
`
INDIANA RETAIL TAX EXEMPT PAGE
City of C�lrmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
•'i
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 f__REqUISITION NO. VENDOR NO. DESCRIPTION
Child Sourco Carmoi Poilco Dopartmont
VENDOR TOHIP 3 CIVIC $gdlm
7009 Wooster Phis Cool, IN 4M
M--dim, CH 442 (317)571-209
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 09• D.05
9 Each Tdan 5 Carsealt 5W 3701198 $57.75 $57:75
6 Each Voyager Highback 93-211FSM $29.00 $179.40
8 Each Than 5 Carsea 7020�_f� $61.15 $489.20
9 Each Safety 1st Designer Car Seat CO $03.90 $575.10
1 Each shipping charges p . I $229.07 $229.07
°. • � Sub Totd: $1,530.52
s� �o
G 19
Send Invoice To:
Camol Pollco Dopwtmont
Attn:Toms@ Andomon
3 Civic Squm
Carmel, IN dam= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. i' PAYMENT $1,5M.52
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRIATION SUF PCIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �•►�%
6
SHIPPING LABELS. /
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE ,BI�8A Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
�
° CLERK-TREASURER
DOCUMENT CONTROL NO. 2`6 2 3® A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or 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))
08/17/12 193504 car seats $732.10
08/17/12 193503 car seats $1,503.32
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
$2,235.42
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26231 193504 -590.05 $732.10
I hereby certify that the attached invoice(s), or
_
bill(s) is (are) true and correct and that the
26230 193503 -590.05 $1,503.32
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, September 06, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund