217592 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $1,117.90
MEDINA OH 44256
CHECK NUMBER: 217592
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25639 202325 1, 117 . 90 CAR SEATS
�s Soup Invoice
Invoice Number: 0000202325
7001 Wooster Pike,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Date: 2/11/2013
REMITTANCEADDRESS: Invoice Due Date: 3/13/2013
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O.BOX Sales Order: 0000114409
CLEVELANDND,,OH 44193
Tax ID#82-0563593
s •. - a r-, �. ,ti �:; �� �.`.Sh�p„Tow's �; ,H; . ,;� � �
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPT.
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032-2584 USA 317-571-2720
Carmel, IN 46032 USA
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�g �G•.u,inmer.Pn ...� ,�. f a c - m � �
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25639 FEDEX GRND ORIGIN Net 30 Days
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IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 8 I� $ 75.0000 $ 600.00
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 ! $ 47.2000 $ 377.60
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Tracking Numbers: 066443715782414, 066443715782421, 066443715782438, 066443715782445, 066443715782452, 06644;
Subtotal 977.60
Freight 140.30
Sales Tax 0.00
Pavment/Credit Amount 0.00
Balance 1117.90
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CotY ® C�JS (� C INDIANA RETAIL TAX EXEMPT PAGE
rm�1.�� TIFICATE NO.003120155 002 0
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' PURCHASE ORDER NUMBER
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FEDERAL EXC:SE TAX EXEMPT
ONE CIVIC SQUARE 35-60000972 25
CARMEL, INDIANA 46032-2584 THIS NUMBER MUST APPEAR ON INVOICES,A/P
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARME VOUCHER, DELIVERY MEMO, PACKING SLIPS,
L- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED
REQUISITION NO. VENDOR NO.
j 9r1 DESCRIPTION
Child Source
VENDOR
Carmel Police Department
SHIP i
7109 �lloostorPike To 3 Civic Square
Modina, OH 44256 Carmel,
ry el, IN 4M
CONFIRMATION BLANKET CONTRACT (31 e )5571-25%
PAYMENT TERMS
FREIGHT
QUANTITY UNIT OF MEASURE
DESCRIPTION
Account w UNIT PRICE EXTENSION
Ij.�
Each
Each
8 Each High Back Booster Front Adj q�
8 Each On 6oard35 Infant Car Seat $47.20 $377.60
1 Each shipping $75.00 $600.00
5140.30 $140.30
Sub Total: $1
lend Invoice To: Q
CaMGI Police Department
Attu:Teresa Andeison
3 Civic Square
Carmel, IN 42= PLEASE INVOICE IN DUPLICATE
DEPARTMENT A ACCOUNT
rrnel Police Dept. r C� PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $1,'197.9
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
SHIPPING INSTRUCTIONS VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIP REPAID. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
PHIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 da C�
\ND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE vah11 Y of f p�of lco
)CUMENT CONTROL NO. A •� COPY_SIGN AND RETURN TO CLERK'S OFF
ICE
VOUCHER NO. WARRANT NO.___._.._-
ALLOWED 20
IN THE SUM OF$
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II ON ACCOUNT OF APPROPRIATION FOR
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Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), or
�i DEPT.# 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
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20
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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))
02/11/13 202325 car seats $1,117.90
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
IN SUM OF $
7001 Wooster Pike
Medina, OH 44256
$1,117.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO, ACCT#/TITLE AMOUNT Board Members
25639 ( 202325 I -590.05 I $1,117.90 1 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
Thursday, February 21, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund