223426 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
` CARMEL, INDIANA 46032 PO BOX 73714 CHECK AMOUNT: $1,161.90
r CLEVELAND OH 44193
CHECK NUMBER: 223426
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25390 212671 1, 161 . 90 CARSEATS
00 O O
O
Al�O r-(" Invoice
Invoice Number: 0000212671
7001 Wooster Pike,Medina,OH 44256
Ph:330.723.4739 Fax:330.72 1.6799 Invoice Date: 8/14/2013
REMITTANCE ADDRESS: Invoice Due Date: 9/13/2013
WESTERN RESERVE DISTRIBUTING,INC.
dba CHILD SOURCE Customer: CARMPD
P.O.BOX 73714 Sales Order: 0000119035
CLEVELAND,OH 44193
Tax ID#82-0563593
j{r�; 5cld TT"""' p l
...... �....1 ° ...`:'�:.w�ii.•"� £�ht•�t... ..,r a. .�.j._ ........ .... 'v..= w ,.....a S.n<.....a.•n.? 65..._£:.
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL, IN 46032-2584 USA Carmel,IN 46032 USA
a,s`'pcVLl7rT P Q: .s Jltl IFS - �wr., •'`� �' " aaT'� ••y ..,.... '� _-
«� r ., �.
25390 LTL-ESTES ORIGIN Net 30 Days
' .ajll�`'.., ...'..a,,r �..a� .,,...,.,.�:,:,. `�`• _1�.5'GFi 1QL n f hl „BCI'a 1:1.mr CC ” 0llnt,� a
3702098 TITAN 5 CARSEAT 50#2PK 6 $ 57.7500 $ 346.50
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 3 $ 77.4000 $ 232.20
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 6 $ 47.2000 $ 283.20
3431198 Chase No Harness 40-110 lbs(18-49,8kg) 4 $ 26.9500 $ 107.80
Booster Car Seat, Factory Select 2 pack
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER PACK) 4 ! $ 14.9000 S 59.60
------ --------------------------- - --------------- --------- -------------- LAST ITEM - -
Tracking Numbers: 1 55-1 621 547
Subtotal 1,029.30
Freight 132.60
Sales Tax 0.00
Payment/Credit Amount 0.00
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 1!l PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT �f
35-60000972 2W
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
8111 I013
Child Smite@ Carmel Police Department
VENDOR SHIP 3 Civic Square
TO
9001 Wooster Pike Carmel, IN 4
Medina, OH 44 (317)571 2
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00.6
1 Each shipping charges $132.60 $132.60
4 Eadi Chase No Harness Booster 3431198 $26.95 $107.80
4 Each Bacidess Shieldiess Booster �a � $14.90 $590
6 Each High Back Booster Front Add ��� �-J�' $47.2 $283.20
3 Each On Board35 Infant Car Sep '1o_*80 $77.40 $232.20
6 Each Than 5 Carsea1 � »37b2098� � $57.75 $346.50
Sub Total. $1,161.90
I
cvp
Send Invoice To:
� 13
Carmel Police Department
Attn:Teresa Anderson
3 Civic Square
Carmel, IN 4g0-323m PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
Cannel Police Dept. PAYMENT $1,161.90
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
�`"-•- NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPERISWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY TH AT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATIOWSUFF
SHIP REPAID. ICIENT TO PAY FOR„THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY ^•'
SHIPPING LABELS. pa �q
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE C ad of
Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. y
rC 5390 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO....___.._.__..__._ _WARRANT NO._------_.,-.--
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# 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.--------------- .__..__..............................
_....---.-_...-_
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
$1,161.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
25390 I 212671 I -590.05 I $1,161.90 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
Wednesday, August 21, 2013
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))
08/14/13 212671 car seats $1,161.90
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