215600 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $334.65
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
MEDINA OH 44256 CHECK NUMBER: 215600
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25549 199284 334 . 65 CAR SEATS
�ou e e
e hil e' Invoice
Invoice Number: 0000199284
7001 Wooster Pike, Medina,OH 44256
Ph:330.723.4739 Fat:330.721.6799 Invoice Date: 12/7/2012
REMITTANCE ADDRESS: Invoice Due Date: 1/6/2013
WESTERN RESERVE DISTRIBUTING, INC.dba CHILD SOURCE Customer: CARMPD
P.O.BOX 73714 Sales Order: 00001 12886
CLEVELAND,OH 44193
Tax ID#82-0563593
. ..`?., sb>• " b„a... p �.�.�.�_ 'z.a�s ._."z 7rJ�11I3 TO n ;„ � ;aw �\: �.aw..• '..,.r7,<:�., •�;�iy
CARMEL POLICE DEPARTMENT, CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL, IN 46032-2584 USA CAR SEAT PROGRAM
ATTN: MAGGIE
Carmel, IN 46032 USA
—_
:.q�Cusfctmer �
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25549 FEDEX GRND ORIGIN Net 30 Days
Item'
.•,, too
°.Desc�rip
,..,.:.:� �.�.,.. �..�..�.at.:;� -`' ,-:�.;.�.:�:-.::<� �� . ?>:�Y•.Shipped t
.:.� Ut'.Pricemrty���a�mourit�'
3702098 TITAN 5 CARSEAT 50#2PK 4 $ 57.7500 $ 231.00
93-211 FSM VOYAGER HIGHBACK(2 PER PACK) 2 $ 29.9000 $ 59.80
LAST ITEM
Tracking Numbers: 066443715721901, 06644371 5721 91 8, 066443715721925
Subtotal 290.80
Freight 43.85
Sales Tax 0.00
Payment/Credit Amount 0.00
' \Jalarice 334.65
INDIANA RETAIL TAX EXEMPT PAGE
City o CERTIFICATE NO.003120155 002 0 1i Carmel 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
`121812
Child Source Camel Police Dopart rent
VENDOR SHIP 3 Civic square
TO
7001 Wooster pike Carmel, IN
I
Medina, OH 442-65 :(317)571
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-690.06
9 Each shipping charges $43.85 $43.85
2 Each VoWger Highback 93-211 FSM $29.90 $59.80
4 Each Than 5 Cerseal 5W �,37� ��,--.� $5715 $231.00
t i Scab Total: $334.05
S
ell
V,
4x• s.., • `tie Yt
"�^•-^.�„ t��,�4(�J e•s x ' �yf�. {5 oar[�'`i
Send Invoice To: '� I
Jr, j
Camel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 4 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Felice Dept. --1 K_ PAYMENT .65
• 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�T,AVIHERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY //// vw-�
SHIPPING LABELS. Cl�i Af of Police
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE #1
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO.
A. 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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
IN SUM OF $
7001 Wooster Pike
Medina, OH 44256
$334.65
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25549 199284 -590.05 $334.65
I hereby certify that the attached invoice(s), or
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
Friday, December 14, 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))
12/17/12 199284 car seats $334.65
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