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Home My WebLink About233249 06/04/14 (9, CITY OF CARMEL, INDIANA VENDOR: 357526 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,035.28* CARMEL, INDIANA 46032 DEPT 10241 CHECK NUMBER: 233249 CHECK DATE: 06/04/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 2360749-01 294.25 SPECIAL DEPT SUPPLIES 102 4239011 237715 585.00 SPECIAL DEPT SUPPLIES 102 4239011 532194 156.03 SPECIAL DEPT SUPPLIES ORDER# ORDER DATE IDUE DATE 19271495 05/13/14 1 06/18/14 D&B#:01-243-0880 WHSEDEA# RHO162494 FedID:11-3136595 CONTAINS MULTIPLE INVOICES ME _cin gg WINE - g rom SMALL 1 116-4408 EA REGULATOR 02 BRSS 0-25LPM 2-DISS 3 3 52.01 156.03 RODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE MATUFAC=ER. PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TE ZMS OF SALE '4/F: TOM SMALL MERCHANDI E TOTAL 156.03 Invoice Date + 30 days 156.03 Please remi-_ payments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, I60055-0241 REM KEY _S Se, ol� Ki BILL TO SHIP TO INVOICE# INVOICE AM;OU.NT ITEM STATUS KEY FSK B-Backordered;Item will follow 1308571 1308572 532194-01 156.03 D-Discontinued;Item no longer available 'C No Charge F-Special Schein Free Goods ORDER# ORDER DATE INVOICE DATE OP BOXES M-Manufacturer will ship Item directly to you P Prescription Drug;Return Authorization Required 19271495 05/13/14 5/19/14 R Refrigerated Item:May be shipped separately $ Special Sche CUSTOMER PO# PAGE# T-Taxable Itemin Pricing Temporarily unavailable;please reorder TOM SMALL 1 OF Item has MSDS LP300 poirds/credits redeemable for certain goods or services,in accordance with discount program rules.Upon discount receipt by redemption at your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,we suggest that you check the shipping container and packing Inst to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex Works"outside in tic original unopened ppackaging,unmarked and properly packaged.Speical order North America).Title passes at the time the shipment is loaded at the shipper's deck. equipment is tial returnable.Aliequipment returns are subject to a restocking tee. Equipment is backed by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warfanty information required immediately upon taking delivery of All orders will be.subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additional freight charges. prescription Doig Returns: Alaska Hawaii&Pacific Protectorates: Please nate that,in order to ram Iv with Federal and State Pedigree requirements, p, q Standard shipping methods provide direct,reduced cast,expedited air delivery Henry Schein's policy on the return of Rx Drugs is as follows: y service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Henry Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items will be identified in vour invoice with the rade WH. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased by Henn,Schein directly from the manufacturer mail Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the following key elements are met: Commodity ID 8000)are now available via LIPS 2nd-day air. 1 Only returns clue to error in order or delivery will be allowed. Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: 2 Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days • All orders will be subject to a handling charge. ]his charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Art requires any customer returning Fix Drur s • Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization term.FederTlaw Parcel Services(UPS)for an additional charge.No minimmn order amount or weight requires that the healthcare entity retuming Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession :states Outside U.S.(50 and during the return of the product.To get a copy of the form and proper return ( )- authorization,please contact Customer Service. if your order is being shipped outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require that the healthcare entity returning nternational Terms&Conditions at henryscheih.com.Unless otherwise agreed, Rx Drugs certifies freight terms are FOB Shipper's Dock("Ek Works"outside North America). that the product being returned is the same exact product purchased from HSI. Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way. RX PRODUCTS& CONTROLLED SUBSTANCES: CHO_OSEYOUR PAYMENT METHOD Regulation -req uire us to limit the sal eof Rx an cont-rolled-subst ices only to ietpstered,, 20%Cash Back or Maximum Rewards on all purchases with the Henry Schein licensed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.600.398.9290 or online please furnish us;yith a copy of your updated state DEA registration.For controlled tvivw.henryschein.com/credhcard Reduce the cost and administration of paying substances,furnish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. Please note that all orders for controller)substances are subject to a due diligence review please call Customer Service for details. process.Schedule II controlled substances c-an be ordered electronically or by mail. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your kvv=.henr,srhein.com/e222;if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46266 Discover Card when placing your artier.All sales are subject to our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apPly to use or installation of certain products. terms of sale. Be sure to understand and comply with ar y such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: i Henry Schein Medical 3408 Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 8arn-9pin,et. Customer Service: 1.877.344.3402 6:10drn-5;30prn,et. Customer Service: 1.800.845.3550 8:30anh-5:30prn,at Place an Order 1.800.772.4346 8ani-9pnh,et. Place an Order. 1.877.344.3402 8:30am-5:30pni,et. Place an Order 1.600.845.3550 8:30am-5:30pm,et Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours. Internet: www.henryschein.corn/medical E-Commerce Support: 1.800.711.6032 Sam-bpm,et. Internet: www.lie nrysdiein.coni/ems E-Mail: custseru@henryschein.com Internet: E-Mail: scott.bruner@henryschein.com E-Mail: custonher.support@henryschein.com Please see:littp:/,Wt;Rv.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions. -------------------------------- ----------------------------- ------ OiDER# ORDER DATE 11)"S DATE 19445473 05/20/14 06/19/14 D&B#:01-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 N, N «wx M A I a MER 1111 rhis order has been processed by our MIDWEST D.C. 5315 WES" 74TH TREET INPIANAP LIS,IN 46268 1 220-1398 3/ST BODY STRAP SET DISP YELLOW 100 100 5.85 585.00 1 PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSIIRES/TE ZMS OF SALE MERCHANDI E TOTAL 585.00 Invoice Date + 30 days 585.00 Please remi: payments only to the following aldress: 4enry Scheii, Inc. Dept CH 10211 Palatine, I60055-0241 BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 1308572 23571&-01 585.00 D-Discontinued;Item no longer available NC-Nncharge F-Special Schein Free Goods .R# ORDER DATE INVOICE DATE 4 OF BOX M-Manufacturer will ship Item directly to you P Prescription Drug;Return Authorization Required 19445473 05/20/14 5/20/14 1 R Refrigerated Item;May be shipped separately $ Special Schein Pricing CUSTOMER PO H PAGE# T-Taxable Item —1y Temporarily unavailable;please reorder TOM SMALL I I OF 1 Item has MSDS LP300 poirdstcredits redeemable for certain goods or services,in accordance with discount program rules.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment.we suggest that you check the shipping container and packing list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,freight terms are FOB Shipper's Dock(Ex Works"outside. in the original unopened packaging,unmarked and properly packaged.Speical order North America).Title passes at the time the shipment is loaded at the shipper's dock. equipment is not returnable.Alrequipment returns are subject to a restocking tee. Equipmentis backed by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon faking delivery of All orders will be subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additiona(freight charges. Prescription Doig Returns: Alaska,Hawaii&Pacific Protectorates: Please note that,in order to comply with Federal and State Pedigree requirements, Standard shipping meUiods provide direct,reduced cost,expedited air delivery Henry Schein's policy on the return of Rx Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Heng Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items will be identified in your invoice with the code NIH. No additional surcharges apply,except when special services are requested. Rx Drugs which are;purchased by Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepter)quantities and Consumer be returned providing that the following key elements are met: Commodity ID 8000)are now available via LIPS 2nd-dci;air. 1 Only returns clue to error in order or delivery will be allowed. Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: 2 Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days • All orders will be subject to a handling charge.This charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Drugs • Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law Parcel Services(UPS)for an additional charge.No minimum order amount orweight requires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product.To get a copy of the form and proper return Outside U.S.(50 states): authorization,please contact Customer Service. It your order is being shippers outside the U.S.(50 states),please refer to the 4)In addition,Pedigree regulations require:that tie healthcare entity returning International Terms&Conditions at hennvschein.min.Unless otherwise agreed, Rx Drugs certifies freight terms are FOB Shipper's Dock("Ex Works"outside North America), that the product being returned is the same exact product purchased from HSI. Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way. RX PRODUCTS& CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD -_Re(fola6ons�eguire us tolimit'the sale of-Rx and controlled substances-only-to regi5tered.---2q;Cash Back or Maximum Rewards on-all-purchases with the Henry Schein — - licensed healthcare professionals.If you are a neve customer or have recently moved, Credit Card.To apply now,call:1.860.398.9296 or online please furnish us with a copy of your updated stale DEA registration.For controlled www.henr schein.com/creditcard Reduce the cost and administration of In substances.furnish a copy of your DEA registration verifying your shipping address. y paying Please note:that all orders for controlled substances are subject to a due.diligence review Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. process.Schedule 11 controller)substances can be ordered electronically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your Sv�tiM1v.henrdschein.com/e222;if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apply to use or installation of certain products. terms of sale. Be sure to understand and comply wdh any such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. i To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 3408 Program Henry Schein MedicallEMS Customer Service: 1.800.472.4346 8am-99prn,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,of. Customer Service: 1.800.845.3550 8:30vvrn-5:30pin,et Place an Order. 1.800.772.4346 8anr9pm,et. Place an Order: 1.877.344.3402 8:30am-5:30pm,et. Place an Order: 1.800.845.3550 8:30am-5:30pm,et Fax an Order. 1.808-329.910924 Hours. Fax an Order. 1.888.805.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours. Internet: wmv.henryschein.com/medical E-Commerce Support: 1.800-711.6032 Sam-bpm,et. Internet: a uww.henryschein_com(ems E-Mail: custserv@henryschein.com Internet: www.henryschein.comr340B E-Mail: scoti.bruner@henryschein.com E-Mail: customer.suppoit@henryschein.coin Please see:http:/Jvnnv.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Excerptions. ORDER# ORDER DATE IDUE DATE 19279483 05/13/14 06/12/14 D&B#:01-243-0880 WHSE DEA# RH0162494 Fed ID:11-3136595 P his order has been processed by our MIDWEST D.C. � 5315 WEST 74TH TREET INDIANAP LIS,IN 46268 OM SMALL 17-571-266 1 935-6155 50/PK BLUE SENSOR SP ELECTRODES 25 25 11.77 294.25 1 LEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSTRES/TEZMS OF SALE ---------- -------------------------- MERCHANDI E TOTAL 294.25 Invoice Date + 30 days 294.25 Please remi payments only to the following a dress: Henry Schei , Inc. Dept CH 10211 Palatine, I 60055-0241 LL TQ SHIPCE E AMOUNT ITEM STATUS KEY REM KEY B-Backordered;Item will follow SK-School Kit 1308571 1308572 2360749-01 294.25 D-Discontinued;Item no longer available NC-No Charge F-Special Schein Free Goods ORDER# ORDERDATE TUVOICE DATE # OF BO Pq M-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 19279483 05/13/14 5/13/14 1 R-Refrigerated Item:May be shipped separately $ -Special Schein Pricing CUSTOMER PAGE T-Taxable Item U-Temporarily unavailable;please reorder TOM SMALL 1 OF 1 •-Item has MSDS LP300 pointsicredits redeemable for certain goods or services,in accordance with discount program rules.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,we suggest that you cheek the shipping container and packing list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Equipment must be returned Unless otherwise a(,lreed,freight terms are FOB Shipper's Dock('Ex Works"outside in the original unopened packaging,unmarked and properly packaged.Sprical order North America).Title passes at the time the shipment is loaded al the shipper's dock. equipment is riot returnable.At equipment returns are subject to a reslo,%ing fee. Equipment is backed by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon taking deliver of All orders will be subject to a handling charge.This charge includes freight,except for your new equipment.Open or defective equipment is subject to the manufacturers additional carrier charges related to special delivery services and hazardous material warranty. shipnients.Special orders are subject to additionalfreight charges. Prescription Drug Returns: Alaska.Hawaii&Pacific Protectorates: Please note that,in order to comply with Federal and State Pedigree requirements, Standard shipping methods provide direct,reduced cost,expedited air delivery Henry Schein's policy on the return of Rx Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Hennr Schein has purchased from wholesalers are not returnable. are offered direct surface transport,or postal services for reliable delivery. These items will be identified in your invoice with the code WH. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased by Henry Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepter(quantities and Consumer be returned providing that the following key elements are met: Commodity ID 8000)are now available via LIPS 2nd-day air. 1)Only returns(hue to error in order or delivery will be allowed. Guam.Puerta Rico,U.S.Trust Territories&Virgin Islands: 2)Returns of Rx Drugs will only be accepted it HSI is notified within 14 calendar days • All orders vrill be subject to a handling charge.This charge includes freightthrough of receipt of the shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs • Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal law Parcel Services(UPS)for an additional charge.No minimum order amount orweight requires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage and handling conditions while in their possession and during the return of the product.To gel a copy of the form and proper return Outside U.S. b0 states): �� authorization,please contact Customer Service. If your order is hemi shipped side the U.S.(50 states),please refer to the 4)In addition.Pedigree regulations require that the healthcare entity returning International Terms&Conditionsoutat hennrsehein.com.Unless otherwise agreed, Rx Drugs certifies freightter ms are FOB Shipper's Dock("Ex Works"outside North Ain erica) that the product being returned is the same exact product purchased from HSI. Title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for ars;returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or where the labeling has been altered in any way. RX PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD_ _ _ —Regulations-rr"uire us to limit the-sale of Rx and controlled substances only to registered, 2%Casio Back or Maximum Rewards on all purchases iruitli the Henry Schein licensed healthcare professionals.If you are a new customer or have recently moved, Credit Card.To apply now,call:1.666.398.9296 or online please furnish vis with a copy of your updated slate DEA registration.For controlled www.henryselhein.ceiii/creditcard Reduce the cost and administration of paying substances,,furnish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay. Please note that all orders for controlled substances are subject to a due diligence review process.Schedule II controlled substances can be ordered electronically or 6y mall. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wm,v.henrvsChein.com/e222,if you preferlo continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Check.If you prefer, Schedule II controlled substances,please mail the form to: YOU may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 Discover Card when placing your order.All sales are subject to our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable within agreed Local regulatory requirements may apply to use or installation of certain products. terms of sale. Be sure to understand and comphr with any such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 11.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 340B Program Henry Schein Medlcal/EMS Customer Service: 1.800.472.4346 8am-91)m,et. Customer Service: 1.877.344.3402 8:30arn-5:30prn,el. Customer Service: 1.800.845.3550 3:30am-5:30pm,et Place an Order 1.800.772.4346 Bam-9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order. 1.600.845.3550 8:30am-5:30pm,et Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours. Internet: www_henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam-bpm;et. Internet: www.lienrVschein.com/erns E-Mail: custsery@henryschein.com Internet: urvrw.henryschein.com/340B E-Mail: scoti.bruner@heoryschein.com E-Mail: cirstoniecsirpport@henryschein.com Please sae:http:/Mvtv.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions. VOUCHER NO. WARRANT NO. ALLOWED 20 Henry Schein IN SUM OF$ Dept Ch 10241 Palatine, IL 60055 $1,035.28 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 237715 102-390.11 $585.00 1 hereby certify that the attached invoice(s), or 1120 2360749-01 102-390.11 $294.25the bills) is (are)true and correct and that 2- 1120 532194 102-390.11 39 $156.03 materials or services itemized thereon for which charge is made were ordered and received except JUN - Z 2014 11hi-71po' - Fire Chile 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)) 237715 $585.00 2360749-01 $294.25 532194 $156.03 I 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