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Home My WebLink About238885 11/05/14 w.4.�q ��' " � CITY OF CARMEL, INDIANA VENDOR: 363647 ONE CIVIC SQUARE MEDTECH FORENSICS, INC CHECK AMOUNT: $" '**'*307.95` f ,' CARMEL, INDIANA 46032 4369 HUGGINS HILL LANE CHECK NUMBER: 238885 9M,�TON-�b• TALLAHASSEE FL 32311 CHECK DATE: 11/05114 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4342100 21708 33.00 POSTAGE 1110 4239099 32484 217'08 274.95 FACE MASKS j 7 MEDTECH Forensics,Inc. Invoice 4369 Huggins Hill Lane ' Tallahassee, FL 32311-0731 Date Invoice# (850) 878-7061 10/24/2014 21708 (850) 878-6103 FAX Bill To Ship'To Carmel Police Department Carmel Police Department 3 Civic Sqquare 3 Civic Square Carmel,IN 46032 Carmel, IN 46032 Attention: Pat Young Attention: John Elliott Attention: P.O. #32484 P.O.Number Terms Rep Via Due Date Interest..will_be_charged.at-the rate - - _ of 1.5%per month on past due P.O. #32484 Net 30 JEH UPS 11/23/2014 balance. Quantity Item Code Description Price Amount 1 3152 RTX, 60mL 58.00 58.00 2 HUD20031Z Sterile Water Capsules, 3mL, 100/box 22.00 44.00 1 ALP-695 Face Mask,N95 NIOSH Particulate Mask, 144.00 144.00 210/cs 1 3114 "RAY" Mixture (Rhodamine 6G-Ardrox-Yellow 28.95 28.95 40), Premixed, 1 Liter 1 SH Shipping and Handling 33.00 33.00 Thank you for your business. Total $307.95 www.medtechforensics.com INDIANA RETAIL TAX EXEMPT PAGE City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 32494 35-60000972 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. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 10M4M2 14 MEDTECH Forensics, Inc Cannel Police Depaftm@nt VENDOR SHIP 3 Civic Square 4369 Huggins Dill Late TO Capel, IN 4603.2 Tallahassee, FL2-311.07,31 (317)571-2.%9 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 42-M.99 1 Each RTX, 60ml 3152 $53.00 $58.40 2 Each Sterile Water Capsules, 3ml 1001box HUD20031Z $22.00 $44.04 1 Each face mask, N95 NIOSH partical mask ALP-695 $144.00 $144.00 1 Each "RAY' Mixture, premixed 1 litre ?X39 ;�`��r � $28.95 $28.95 .I I � 14 �-- (1 I Sub Total, $274.95 ,tQj > f r j} 1� I ( ,I v d- _ •. I��s. w�f Quote#4033 Send Invoice To: Cannel Poilco Department Attn: Pat Young 3 Chic Square Gabel, IN 460132- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT Camiel Police Dept. PAYMENT $274.95 • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFYTHATTJIERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIA�8 EFICIENT TO PAY FOR THE ABOVE ORDER. •SHIP REPAID. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. /� •PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY / _44 gy SHIPPING LABELS. hl[Y of Police •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. / /� CLERK-TREASURER DOCUMENT CONTROL NO. 3 2 4 8 4 A.P.V. COPY-SIGN AND RETURN TO CLERKS OFFICE VOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF$ ON ACCOUNT OF APPROPRIATION FOR r, 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 MEDTECH Forensics, Inc IN SUM OF $ 4369 Huggins Hill Lane Tallahassee, FL 32311-0731 4 $307.95 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 21708 43-421.00 1 hereby certify that the attached invoice(s), or $33.00 bill(s) is (are)true and correct and that the 32484 21708 42-390.99 $274.95 materials or services itemized thereon for which charge is made were ordered and received except Tuesday, October 28, 2014 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund i 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)) 10/24/14 21708 Shipping $33.00 10/28/14 21708 Forensic Supplies $274.95 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