219270 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
` ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $944.68
CARMEL, INDIANA 46032 7001 WOOSTER PIKE
a _a� MEDINA OH 44256 CHECK NUMBER: 219270
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25699 206139 944 . 68 CAR SEATS
• •.
-�� Invoice
child source'
Invoice Number: 0000206139
7001 Wooster Pike,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Date: 4/17/2013
REMITTANCE ADDRESS: Invoice Due Date: 5/17/2013
WESTERN RESERVE DISTRIBUTING,INC. Customer: CARMPD
dba CHILD SOURCE
P.O.BOX 73714 Sales Order: 0000115931
CLEVELAND,OH 44193
Tax ID#82-0563593
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CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL, IN 46032-2584 USA ATTN MAGGIE
Carmel,IN 46032 USA
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FEDEX GRND ORIGIN Net 30 Days
aCTiiit
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE I 6 $ 75.0000 $ 450.00
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 $ 47.2000 $ 377.60
LASTITEM ------ ------------------L------------ ---------=-----------------------------
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Tracking Numbers: 066443715858478, 066443715858485, 066443715858492, 066443715858508, 066443715858515, 06644;
Subtotal 827.60
Freip-ht 117.08
Sales Tax 0.00
Pavment/Credit Amount 0.00
944.68
u0 INDIANA RETAIL TAX EXEMPT PAGE
O I' Carmel CERTIFICATE NO.003120155 002 0\\��//// � 1i 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
41`12I '13
Child Bourse Gaffs! Police Dep mart
VENDOR SHIP
TO 3 Civic Square
7001 Wooster Pike Carrel, IN 4
Maldin2. Oil 442%
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-6W.05
1 Each shipping charges $117.08 $117.08
8 Each High Back Booster Front Adj 93-209FSM $47.20 $377.60
6 Each On l3card35 Infant Car Seat SFS $75.00 $450.00
Sub Total: $9".68
441
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Send Invoice To: :-
Carmel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Can-ael Police Dept. r'-` PAYMENT .
• 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
THIS APPROPRIATIONISUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. {
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. ✓
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE CCh�s Ill
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. �•••�• y• • m••vv
CLERK-TREASURER
DOCUMENT CONTROL NO. A.P. COPY-SIGN AND RETURN TO CLERK'S OFFICE
i
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))
04/17/13 206139 car seats $944.68
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.
Child Source ALLOWED 20
IN SUM OF $
7001 Wooster Pike
Medina, OH 44256
$944.68
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25699 I 206139 I -590.05 I $944.68 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
Friday, April 19, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund