227307 12/17/2013 F CITY OF CARMEL, INDIANA VENDOR: 361470 Page 1 of 1
ONE CIVIC SQUARE CHILD SOURCE
CARMEL, INDIANA 46032 PO BOX 73714 CHECK AMOUNT: $1,235.40
CLEVELAND OH 44193 CHECK NUMBER: 227307
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CHECK DATE: 12117/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
900 4359005 31392 122105 1, 235 . 40 HIGH CHAIRS
INVOICE
MERCURY Invoice Number: 0000122105
Date: 12/10/2013
DISTRIBUTING 0
Confirm No:
Salesperson:
305 Lake Road, Medina, OH 44256
Customer: CARMPD
Ph: 330.723.4739 Fax: 330.721.6799
Customer PO: 31392
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CARMEL POLICE DEPARTMENT,CITY TRINITY CLINIC
DO NOT MAIL INVOICE 1045 OAKRIDGE ROAD
CARMEL, IN 46032-2584 USA Carmel, IN 46032 USA
Contact: XYZ
Phone: (860)292-8240 Ext: AP Tmi
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12110/2013 UPS L ORIGIN I Net 30 Days
a�;., ;h 'C .,,E {. s np.«¢ s e.,;� «�7 ,. 4"� '�,, <.c ,.tom '*F.'w, "^1
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.dek® exed. ..._ nit Puce s.. no>
I IC068FSM 6 0 0 Each $77.4000 $464.40
ON BOARD35 INFANT CAR SEAT W/BASE
2 93-209FSM 4 0 0 Each $47.2000 $188.80
HIGH BACK BOOSTER FRONT ADJ 2PK
3 3702098 4 0 4 Each $57.7500 $231.00
TITAN 5 CARSEAT 50#2PK
4 3431198 8 0 0 Each $26.9500 $215.60
Chase No Harness 40-110lbs(18-49,8kg)
Booster Car Seat,Factory Select 2 pack
Prepayments: Product: 1,099.80
Discount: 0.00
Freight: 135.60
Sales Tax: 0.00
APPROVED BY:
Total : 1,235.40
Deposit:
X
H� I'a USD 1,235.40
_
Printed On: 12/10/2013 @ 10:45:46AM
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 la. PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 31
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.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Child Bourco
VENDORMostwn Roser Diot ibuting, Inc. SHIP
� <�(In
TO CJ-
PA. Box 73M �
Cleveland. OH 44193
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00.690.05
1 Each shipping charges $135.50 $135.60
8 Each Chase No Harness Booster 3431198 $26.95 $215.60
4 Each Titan 5 Carseat 3702998 $57.75 $231.00
� i jt 1 >
4 Each High Back Booster Front Add ��°� �� o`� ��,� $47.20 $188.80
6 Each On Board35 Infant Car Seat a lC68F $77.40
Bab Total: $1,235.40
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Send Invoice To:
c�a
Carmel Police Department
Attn:Terosa Anderson
3 Civic 8quam
Carmel, IN 4 - PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Cafmal Police Dept. ��'�^ ���' PAYMENT
$1,23 .40
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT HERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRI dl5 �S FFICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. _Z1
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE C of nq Pollen
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER ,
DOCUMENT CONTROL NO. 31392 ' A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO._ WARRANT
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
f.
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Child Source
Western Reserve Distributing, Inc. IN SUM OF $
P.O,. Box 73714
Cleveland, OH 44193
$1,235.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Grant Fund
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT
Board Members
31392 I 122105 I -590.05 I $1,235.40 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
Wednesday, December 11, 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))
12/10/13 122105 car seats $1,235.40
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
, 2o
Clerk-Treasurer