226263 11/19/2013 CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
0 CHECK AMOUNT: $849.44
CARMEL, INDIANA 46032 PO BOX 73714
o� CLEVELAND OH 44193 CHECK NUMBER: 226263
CHECK DATE: 11/19/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 25461 217717 849 . 44 CARSEAT
-� MERCURY Invoice
DISTRIBUTING
305 Lake Road, Medina, OH 44256
Ph:330.723.4739 Fax:330.721.6799 Invoice Number: 0000217717
REMITTANCE ADDRESS:
WESTERN RESERVE DISTRIBUTING,INC. Invoice Date: 11/7/2013
dba MERCURY DISTRIBUTING or CHILD SOURCE
P.O.BOX 73714 Invoice Due Date: 12/7/2013
CLEVELAND,OH 44193 Customer: CARMPD
Tax ID#82-0563593 Sales Order: 0000121227
CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
3 CIVIC SQUARE 1045 OAKRIDGE ROAD
CARMEL,IN 46032-2584 USA Carmel, IN 46032 USA
- .vua.uint,i� F:t✓.. .. � �I..,n....i; ::�i�:.,. ;��':=�.°" :fiir=.s.�` �i�:;::a>,:?;.•r.: ;^`a-r,'= 7
..,a.;.: ......._....»•,,ss�;=..:..,.m_... ...,u^ �:mz.a:3s....a«._..c..;:o.�..�,.t)�'�Y_.�„.' "S» ..A'.[::l:1cj�°:^s::?.>'' .aw.zz. z�.0ITt1 ._�'�.�°. .a.«.��'.3
25461 TP UPS ORIGIN Net 30 Days
�'.. ' ''I7eseri tion :7 ., t 5hi e ... �<
_... �P :• Y J?P...a�?::.:'t`rUnitPnce, •. �s Amaunt,;-
IC068FSM ON BOARD35 INFANT CAR SEAT W/BASE 2 $ 77.4000 $ 154.80
3431198
h
C ase N o Harness a ess 40-110 lbs 18-49 8k
( g) 6 $ 26.9500 $ 161.70
Booster Car Seat, Factory Select 2 pack
93-299FSM BACKLESS SHIELDLESS BOOSTER(4 PER 4 $ 14.9000 $ 59.60
PACK)
3702098 TITAN 5 CARSEAT 50#2PK 4 $ 57.7500 : $ 231.00
93-209FSM HIGH BACK BOOSTER FRONT ADJ 2PK 2 $ 47.2000 $ 94.40
-------------------------------------------------------------------------------- LAST ITEM -----------------------
i
J
Tracking Numbers: 1 ZA7T667039041 91 1 8, 1 ZA7T6670391481549, 1 ZA7T6670391899125, 1 ZA7T6670392571173, 1 ZA7T66.
Subtotal 701.50
Freiaht 147.94
Sales Tax 0.00
Discount 0.00
Pavment/Credit Amount 0.00
_ << ' $alanc ;Due 849.44
INDIANA RETAIL TAX EXEMPT PAGE
City of CERTIFICATE N0.0031201550020,Carmel PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 25461
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
Guild Source
C �., . ..
VENDOR Stem Reserve Distributing, Inc. TOHIP
PA. Box 73714
Clevela nd, OH W93
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account -M.05
1 Each shipping $147.94 $147.9 •
2 Each Nigh Back Booster Front Adj 93-209FSM $47.20 $94.40
4 Each Than 5 Carseat 68 3 $$57.75 $231.00
4 Each Baddess Shieidiess Booster :�'; : $14.90 $59.60
1119 f
5 Each Chase �harness Booster 04311 $26.95 $161.70
2 Each On Soard35 infant Car Sea 'I °e®`' •• r60'6W `' , t $77AO $154.90
�s Sub Total: $849.44
:�. ,, ..n•.. ,. :Ys
Send Invoice To:
Camel Police Departmia t
Attn-Teresa Anderson /
3 Civic Square
Cannel, IN 46M2- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Cannel Police Dept. PAYMENT $849.44
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN J
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL V
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. V
4 � CLERK-TREASURER
DOCUMENT CONTROL NO:
A COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.__.......----__ .-_-WARRANT NO.,
ALLOWED 20
IN THE SUM OF$
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 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))
11/07/13 0000217717 car seats $849.44
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.
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF $
P.O,. Box 73714
Cleveland, OH 44193
$849.44
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25461 I 0000217717 I -590.05 $849.44
I 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
I
i
fWednesday, November 13, 2013
i
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund