224822 10/08/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 PO BOX 73714 CHECK AMOUNT: $376.55
CLEVELAND OH 44193
,o CHECK NUMBER: 224822
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25430 215463 376 . 55 INFANT CAR SEAT
--�O- MERCURY Invoice
DISTRIBUTING
305 Lake Road, Medina, OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000215463
REMITTANCE ADDRESS: Invoice Date: 10/1/2013
WESTERN RESERVE DISTRIBUTING,INC.
dba MERCURY DISTRIBUTING or CHILD SOURCE Invoice Due Date: 10/31/2013
P.O.BOX 73714
CLEVELAND,OH 44193 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000120343
!ftm— -a-
CARMEL POLICE DEPARTMENT,CITY TRINTIY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL,IN 46032-2584 USA Carmel, IN 46032 USA
25430 TP UPS ORIGIN Net 30 Days
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 4 77.4000 $ 309.60
LAST ITEM J------------------------- ------------'---- ----- ------------------
------------ ............... ............ ---------------------------
Tracking Numbers: 1 ZA7T6670391045609, 1 ZA7T6670392957631, 1 ZA7T6670393448822, 1 ZA7T6670394432819
Subtotal 309.60
Freight 66.95
Sales Tax 0.00
Discount 0.00
Payment/Credit Amount 0.00
376.55
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 254M
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
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. tVENDOR NO. DESCRIPTION
9)27=13
VENDOR TOHIP � L
7001 Wooster Pike
Madina, OH 442
CONFIRMATION BVUNJJT CONTRACT PAYMENTTERMS FREIGHT
` QUANTITY OF MEASU RE DESCRIPTION UNIT PRICE EXTENSION
I
Account 00-6N.05
I Each shipping $66.95 $68.95
4 Each On ®oard35 Infant Car Scat IC088FSM $77.40 $309.80
Saab Total: $378.65
-4
SIG?•° ��
°°• ...... • o
Send Invoice To:
Cannel Police Depar'dent
Attu: Tomoa Anderson
3 CIVIC Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $3765.55
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL /
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE i/ ( Hof of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
J 4 3® CLERK-TREASURER
2
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO._ WARRANT NO.
ALLOWED 20
_ IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoices), 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
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))
10/01/13 215463 car seats $376.55
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_S_cum
Western Reserve Distributing, Inc. IN SUM OF $
P.O,. Box 73714
Cleveland, OH 44193
$376.55
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25430 215463 -590.05 $376.55 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
Thursday, October 03, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund