101842 CHILD SOURCE INDIANA RETAIL TAX EXEMPT Page 1 of 1
Cityof Carme CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101842
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
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. VENDOR NO. DESCRIPTION
8/6/2018 361470
CHILD SOURCE Trinity Clinic
VENDOR 305 LAKE ROAD SHIP 1045 W 146th St.Suite-B
TO Carmel, IN 46032-
MEDINA,OH 44256- Ann Gallagher
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
28224
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 900 Grant Fund
Account: 43-590.05
4 Each 93-299FSM backless shieldless booster 4 pk $14.90 $59.60
6 Each 3431198 Chase no harness 40-110Ibs booster 2pk $26.95 $161.70
8 Each 3102198 Maestro 50 combo booster 20-100Ibs $58.30 $466.40
6 Each IC201CHZ OnBoard 35(4-35 lbs)with adjustable base and up front $78.00 $468.00
adjust
1 Each shipping charges $143.00 $143.00
8 Each 3472198 Sonus Convertible Seat 2PK. $57.75 $462.00
Sub Total $1,760.70
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Send Invoice To: r x'
Police Department
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3 Civic Square k
Carmel, IN 46032- � ..w....a '"
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT ! PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $1,760.70
'NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
`SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
`C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
*PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL ^
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 cS,{JC,•"' et4l
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY `�
Jim Barlow \`1
TITLE Chief
CONTROL NO. 101842 CLERK-TREASURER �\;e\
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