213880 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
�tONE CIVIC SQUARE CHILD SOURCE
? CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $442.00
o� MEDINA OH 44256 CHECK NUMBER: 213880
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25499 196408 442 . 00 CAR SEATS
e e e
l d sou me- Invoice
EMOMMERM Invoice Number: 0000196408
7001 Wooster Pike, Medina,OH 44256
Ph:330.723.4739 Fax: 330.721.6799 Invoice Date: 10/11/2012
REMITTANCE ADDRESS: Invoice Due Date: 11/10/2012
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000111620
CLEVELAND.OH 44193
Tax ID#82-0563593
a Sold To. Ship To
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL, IN 46032-2584 USA ATTN MAGGIE
Carmel, IN 46032 USA
[� Customer P.O:. , Ship Via_V RO.B Terms
25499 FEDEX GRND ORIGIN Net 30 Days
Item _
'Description _ _ -.,._.:�. _ �Q 'Shipped Unit Price Amount
3702098 TI"hAN 5 CARSEAT 50#2PK 4 $ 57.7500 _ 231.00
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 2 $ 47,2000 $ 94.40
93-21 IFSM VOYAGER HIGHBACK (2 PER PACK) 2 $ 29.9000 $ 59.80
LAST ITEM
Tracking Numbers: 066443715667094, 066443715667100, 066443715667117, 066443715667124
Subtotal 385.20
Freight 56.80
Sales Tax 0.00
Payment/Credit Amount 0.00
m: w ' Balance 442.00
INDIANA RETAIL TAX EXEMPT PAGE
City of Carmel CERTIFICATE NO.003120155 002 0 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
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
10P.4012
Child Source Carmel Police Department
VENDOR SHIP 3 Civic Squam
7001 Wooster Pike TO Carmel, IN 48032
Medina, Oil 44256 (3 17)571
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00 .051
1 Each shipping $56.80 $56.80
2 Each Voyager Hlghback 63-211ES# $29.90 $68.80
2 Each High stack Booster Front $47.20 $94.40
4 Each Tstab 5 Carscat $57.75 $231.00
. .
I`4 � ` . , :" ' •� Saab Total: $442.00
� f3
S;s S
4 rs d
Send Invoice To:
Carmel Police Department
Attn:Terosa Anderson
3 Civic Square
Cannel, IN 4 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT F AMOUNT
Carmel Police Dept. { �,, PAYMENT $442.00
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIAT ON SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ! f.G.-..-•+"-
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Chief of 1 Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2JCa
CLERK-TREASURER
DOCUMENT CONTROL NO. A� • COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.-____T.,- WARRANT
j ALLOWED 20
IN THE SUM OF$
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
VOUCHER NO. WARRANT NO.
Child Source ALLOWED 20
IN SUM OF $
7001 Wooster Pike
Medina, OH 44256
$442.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25499 196408 -590.05 $442.00
I hereby certify that the attached invoice(s), or
I I 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
Wednesday, October 17, 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))
10/11/12 196408 car seats $442.00
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