225316 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE CHECK AMOUNT: $1,044.95
s` o CARMEL, INDIANA 46032 PO BOX 73714
a ;o� CLEVELAND OH 44193 CHECK NUMBER: 225316
CHECK DATE: 10123/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25437 216054 1, 044 . 95 INFANT SEATS
MERCURY Invoice
DISTRIBUTING
305 Lake Road, Medina,OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000216054
REMITTANCE ADDRESS:
WESTERN RESERVE DISTRIBUTING,INC. Invoice Date: 10/10/2013
dba MERCURY DISTRIBUTING or CHILD SOURCE 11/9,2013
P.O.BOX 13714 Invoice Due Date:
CLEVEL,'ND,OH 44193
Customer. CARMPD
Tax 1D#82-0563593 Sales Order: 0000120579
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CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE RD
CARMEL,IN 46032-2584 USA ATTN NANCY
Carmel, IN 46032 USA
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25437 TP UPS ORIGIN Net 30 Days
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 8 $ 47.2000 $ 377.60
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 1 $ 77.4000 $ 77.40
3711198 j TITAN 65 CONVERTIBLE CARSEAT IPK 8 $ 57.7500 $ 462.00
LAST ITEM
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Tracking Numbers: 1 ZA7T6670391165113, 1 ZA7T6670392321880, 1 ZA7T6670392525124, 1 ZA7T6670392773071, 1 ZA7T66,
Subtotal 917.00
Freifzht 127.95
Sales Tax 0.00
Discount 0.00
Payment/Credit Amount 0.00
�: � _r W alq&,'djDuj 1,044.95
INDIANA RETAIL TAX EXEMPT PAGE
City o CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
Jl Qarmel
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
10/7t2013
Child Source Carmel Police Department
VENDOR ittafn R@ siorvo Dlstrihl tang, Inc, SHIP 3 CIVIC Square
TO
PA. Box 73714 Camel, IN 46032
Clevolands OH 441 (397)671-2659
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-M.05
1 Each shipping $127.85 $127:85
1 Each On Beard35 Infant Car Seat IC068FSM $77.40 $77.40
8 Each High Back Booster Front Adj - $47.20 $377.60
8 Each Titan 5 Carseat _ � �°` $57.76 $462,00
' "° _. Sub Total: x$1,044.05
CA
1 i>
4 s
Send Invoice To: ' (
Carol Pollco Depadmerrt
Attn: Temsa Anderson
3 Civic Square
Camel, IN 46O-'V2- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. . PAYMENT $91044.95
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
.�� NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THEIjPROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS 1 HEREBY CEjRffFVTHATTHERE I�N'UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFIC�E_NT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. /
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. /// `A�1J, �J+/-�/
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE '1 hie$of
Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
� CLERK-TREASURER
DOCUMENT CONTROL NO. A. 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 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 it
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF $
1
P.O,. Box 73714
Cleveland, OH 44193
$1,044.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
25437 I 216054 I -590.05 I $1,044.95 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
Thursda October 17, 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))
10/10/13 216054 car seats $1,044.95
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