220996 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
t ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 7001 WOOSTER PIKE CHECK AMOUNT: $307.90
MEDINA OH 44256 CHECK NUMBER: 220996
pox
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25744 208226 307 . 90 CAR SEATS
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rchti-rld source- Invoice
Invoice Number: 0000208226
7001 Wooster Pike,Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Date: 5/28/2013
REMITTANCE ADDRESS: Invoice Due Date: 6/27/2013
WESTERN RESERVE DISTRIBUTING, INC.
dba CHILD SOURCE Customer: CARMPD
P.O. BOX 73714 Sales Order: 0000117008
CLEVELAND,OH 44193
Tax ID#82-0563593
Sold To Ship To
CARMEL POLICE DEPARTMENT, CITY CARMEL POLICE DEPARTMENT
3 CIVIC SQUARE 3 CIVIC SQUARE
CARMEL, IN 46032-2584 USA ANN GALLAGHER
Carmel, IN 46032 USA
Eustamcr P:O.— ter--- _< —Ship_=Via — ----- - - -17,0.13—
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25744 FEDEX GRND ORIGIN Net 30 Days
Item Description Qty Shipped Unit Price Amount
3711198 TITAN 65 CONVERTIBLE CARSEAT 1PK 1 $ 61.2000 $ 61.20
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 2 $ 77.4000 $ 154.80
22253BMQ Cosco Highback Booster (Windmill) 1 $ 49.5000 $ 49.50
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---------------------------------- - LAST ITEM
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Tracking Numbers: 066443715896555, 066443715896562, 066443715896579, 066443715896586
Subtotal 265.50
Freieht 42.40
Sales Tax 0.00
Payment/Credit Amount 0.00
Balance 307.90
C0 INDIANA RETAIL TAX EXEMPT PAGE
ily. o Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 �a
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
024 Pb13
Child Source Carmel Police Department
SHIP
VENDOR TO 3 Civic Square
7M Wooster Plha Camel, IN 460
Modin2l, CN AA2 13171671 M
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 004M.05
1 Each shipping $42.40 $42.40
1 Each Cosco Highbalck Booster(Windmill) 222530M9 $49.50 $40.50
2 Each On Board35 Infant Car Seat $77.40 $154.80
1 Each Titan 05 Cenvertibdkcar seat 1 p r $01.20 $01.20
� Sub Total:al . $307.90
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Send Invoice To:
Carrel Police Department
Attn:T'erosa Andorso
3+Civic Square
Cali el, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT T PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Crept. �� � PAYMENT $307.90
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
�-.. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIAT ON S EFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. `/
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BYb'�
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 1n6e.$saEl 0^112^
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
D 7 4 4 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
�
�
' VOUCHER NO. WARRANT NO`____
�
�
ALLOWED 20___
�
|N THE SUM OFs
ON ACCOUNT OF APPROPRIATION FOR
'
'
^ Board Members �
PO#or� / hereby certify that the attached invnice(e), or
biUbAk� kare> hueandounon� anddx��he '
. . (are)
materials or services itemized thereon for '
which charge ks made were ordered and '
received except.----- �
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20____ !
Signature
/me
Cost distribution ledger classification if
claim paid mom,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))
05/28/13 208226 car seats $307.90
I 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
$307.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25744 I 208226 I -590.05 $307.90 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
Friday, June 14, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund