102009 CHILD SOURCE Io INDIANA RETAIL TAX EXEMPT Page 1 of 1
� 1 o f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
/JL FEDERAL EXCISE TAX EXEMPT 102009
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
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
10/16/2018 i 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
30129
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 900 Grant Fund
Account: 43-590.05
2 Each 3431198 Chase no harness 40-110Ibs booster 2pk $26.95 $53.90
6 Each 3102198 Maestro 50 combo booster 20-100Ibs $58.30 $349.80
6 Each IC201CHZ OnBoard 35(4-35 lbs)with adjustable base and up front $78.00 $468.00
adjust
1 Each shipping charges $156.00 $156.00
4 Each 3472198 Sonus Convertible Seat 2PK. $57.75 $231.00
Sub Total $1,258.70
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Send Invoice To:
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Police Department
3 Civic Square .,7i,;‘';',.,---7-71 ,,,;',, .O
Carmel, IN 46032= ,':
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $1,258.70
SHIPPING INSTRUCTIONS 'NPR VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
*SHIP PREPAID. PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
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 LABELe,....„...„
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*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 t;J" -
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jim Barlow ��
TITLE Chief 13�
CONTROL NO. 1 02009 CLERK-TREASURER