HomeMy WebLinkAbout240889 01/08/15 G�9 .
CITY OF CARMEL, INDIANA VENDOR: 368979
d ONE CIVIC SQUARE FUJIFILM SONOSITE, INC CHECK AMOUNT: $****35,175.37
CARMEL, INDIANA 46032 #774332 CHECK NUMBER: 240889
�M. 4332 SOLUTIONS CENTER CHECK DATE: 01/08/15
CHICAGO IL 60677-4003
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467099 1281680 .02 OTHER EQUIPMENT
102 R4467099 24668 1281680 35,175.35 NAONMAXX
i
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FUJIFILM SonoSite, Inc. (WIMER>
21919 30117 Drive SE FUJIFILM SONOSITE,INC.
SonoSite Bothell,WA 98021-3904 #774332 Number 1281680
FUJI4332 Solutions Center Date 22-DEC-14
Phone:425-951-1200 CHICAGO IL 60677-4003
Fax:425-951-1201 Purchase Order 24668
Our Reference
Sales Order 1073557
Customer Number 237430
Bill To: Ship To:
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
ATTN ACCOUNTS PAYABLE 2 CARMEL CIVIC SQUARE
2 CARMEL CIVIC SQUARE CARMEL, IN 46032
CARMEL,IN 46032
` NET 30 21-JAN-15
MCHUGH,BRIAN-GOV I MATTHEW HOFFMAN 22-DEC-14 i FEDEX 583651867363
1 L12001-05R SONOSITE NANOMAXX, 2 2 8,656.31 17,312.62
REMANUFACTURED
2 P12865-01 USER GUIDE,NANOMAXX, PAPERLESS(CD 2 2 0.00 0.00
ONLY)
3 P11877-12A TRANSDUCER,L38N/10-5 MHZ,NANOMAXX, 2 2 4,267.24 8,534.48
REMFG
Serial Num:03LXNN,03TNY1
4 P11879-20A TRANSDUCER,P21 N/5-1 MHZ,NANOMAXX, 2 2 4,267.24 8,534.48
REMFG
Serial Num:03FZKL,03GR2X
5 P12697-02 CARRY CASE,NANOMAXX 2 2 154.61 309.22
6 P12391-01 ENGLISH USER INTERFACE 2 2 0.00 0.00
7 L09823-01 POWER SUPPLY W/POWER CORD 2 2 154.61 309.22
8 P00848-01 CORDSET,10 AMP,C13 2 2 0.00 0.00
CONN ECTOR,HOSPITAL GRADE,NORTH AMERICAN
9 SHIPPING AND HANDLING CHARGES 1 1 175.35 175.35
10 P09723-12R NANOMAXX DOCK,REMANUFACTURED 2 2 0.00 0.00
Serial Num:03PT7P,040DDV
11 P11111-46R NANOMAXX ULTRASOUND SYSTEM, 2 2 0.00 0.00
1.0.5.2.1, REMANUFACTURED
Serial Num:03HPZH,03MGZR
Special Instructions Subtotal 35,175.37
Tax 0.00
Less Deposit 0.00
35,175.37
Total
Currency: USD
U7 customer is iesponsve for providing Information on all discounts to federal and state government heatfneare programs(including Medicare and Medicaid)and ofnar ontwas m acsordanco with all applicable taws and regulations.
inclWrng without kneflati n 42 C.F.R.f 001.9u(h).
It you sock reimbursement from or submita claim to the Medicare,Medicaid,or other todciral health care programs,as the buyer you are obligated to fully and accurately report the actual discount and corresponding savings to such
healthcare programs,You must not seek reimbursement or submit a claim to such programs for arrefunts In excess of your actual Opal for the items you nave purchased.you are also obligated to provide the terms Of fh0 tlis0obnl upon
inquest by the Secretary of the Department of Health and Human Services or similar state agency.
Drescribed 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))
1281680 $35,175.37
1 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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
3n nc. -if -770Z, IN SUM OF $
aa-aa.e.�e n-�;ve z SD Iu--h orq b K K
snth1 �gd , babT,
$35,175.37
ON ACCOUNT OF APPROPRIATION FOR
Carmei Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
24668 1281680 102-670.99 $35,175.37 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
.JAN
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund