HomeMy WebLinkAbout213407 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
=, ONE CIVIC SQUARE CHILD SOURCE
0 CHECK AMOUNT: $715.90
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 213407
CHECK DATE: 1019/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25474 195292 715 . 90 CAR SEATS
child source Invoice
' Invoice Number: 0000195292
7001 Wooster Pike,Medina,01-1 44256
Ph:330.723.4739 Fax: 330.721.6799 Invoice Date: 9/19/2012
REMITTANCE ADDRESS: Invoice Due Date: 10/19/2012
WESTERN RESERVE DISTRIBUTING,INC.
d Customer: CARMPD
ba CHILD SOURCE
P.O. BOX 73714 Sales Order: 00001 1 1053
CLEVELAND,OH 44193
Tax ID 482-0563593
Sold To Ship To
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE RD
CARMEL, IN 46032-2584 USA 317 819 0772 MAGGIE
Carmel, IN 46032 USA
Customer_F.O .^__ _ __ __Ship_Via _25474 FEDEX GRND ORIGIN Net 30 Days
Item Description Qty Shipped Unit Price Amount
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 6 $ 75.0000 $ 450.00
3812198 TRIBUTE 5 CONVERTIBLE CAR SEAT2PK 2 $ 48.9500 $ 97.90
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER PACK) 4 $ 14.9000 $ 59.60
---- ---------------— LASTITEM -----------------------------------------
Tracking Numbers: 066443715643685, 066443715643692, 066443715643708, 066443715643715, 066443715643722, 06644;
Subtotal 607.50
Freight 108.40
Sales Tax 0.00
Payment/Credit Amount 0.00
_ Balance 715.90
INDIANA RETAIL TAX EXEMPT PAGE
City o li \ %._ �v arm( l CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 255474
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
9097#2092
Child Source Carmel Police Department
VENDOR SHIP 3 Citric Square
7001,Woostor Pikes TO Camel, IN 4
Medina, OH 4426 (W)571
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
Account g UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-690.05
2 Each Tribute 5 Convertible Car Seat 3892108 $48.95 $07.90
8 Each On Board35 Infant Car Seat IC068FSM $75.00 $450.00
4 Each Backless Shieldless Booster $14.90 $59.80
1 Each shipping $108.40 $108.40
C, •. Stab Total: $715.90
Send Invoice To: �00 °"
Camel Pollee Department
Alan:Teresa Anderson
3 CIVIC Squares
Cannel, IN 412= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
, mel Police Dept. PAYMENT $715.90
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT�THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL /
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 4/hIef of
Pollee
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2547 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P. • COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.,......................
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE N0. 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))
09/19/12 195292 car seats $715.90
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
.pO .� IN SUM OF $
$715.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25474 195292 -590.05 $715.90 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
Tuesday, October 02, 2012
4 . Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund