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Home My WebLink About240833 01/07/15 CITY OF CARMEL, INDIANA VENDOR: 362351 b it ONE CIVIC SQUARE SUNSHINE MEDICAL CHECK AMOUNT: $ *"**«552.95* CARMEL, INDIANA 46032 31575 GLENDALE CHECK NUMBER: 240833 'M�rbe co r LIVONIA MI 48150 CHECK DATE: 01/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4239012 124798 3.95 SAFETY SUPPLIES 1110 R4239012 32251 124798 549.00 LATEX GLOVES Sunshine Medical Supply, Inc. Invoice 31575 Glendale St. Date Invoice# Livonia, MI 48150 734-293-7500 fax 734-293-7505 12/16/2014 124798 www.sunshinemedicalsupply.not Bill To Ship To Carmel Police Dept Carmel Police Dept 3 Civic Square 3 Civic Square Carmel, Indiana 46032 Carmel,IN 46032 ATTN: Robert Robinson P.O. Number Terms Rep Ship Via F.O.B. Project Net 15 KMG 12/16/2014 Quantity Item Code Description Price Each Amount 10 SUPRENO-EC-S SUPRENO EC NITRILE EXAM GLOVES BY MICROFLEX 9.15 91.50T SIZE S EXTENDED CUFF,POLYMER COATED 50/BX--10 BX/CS 10 SUPRENO-EC-M-... SUPRENO EC NITRILE POWDER FREE EXAM GLOVES 9.15 91.50T BY MICROFLEX 50/BX--10 BX/CS SIZE M EXTENDED CUFF,POLYMER COATING 20 SUPRENO-EC-L-... SUPRENO EC NITRILE POWDER FREE 9.15 183.00T EXAM GLOVE BY MICROFLEX 50/BX--10 BX/CS SIZE L EXTENDED CUFF,POLYMER COATED 20 SUPRENO-EC-XL... SUPRENO EC NITRILE POWDER FREE 9.15 183.00T GLOVES BY MICROFLEX 50/BX--10 BX/CS SIZE XL EXTENDED CUFF,POLYMER COATED Fuel Surcharge Fuel and Handling Charge 3.95 3.95 Out-of-state sale,exempt from sales tax 0.00% 0.00 Thank you for your business. gLL' Total $552.95 era.: i ' ty INDIANA RETAIL TAX EXEMPT PAGE ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P ` CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 9219294 SunchIno Modical Supply, Inc. Carmel Police Department VENDOR SHIP 3 Civic sglum 39575 Glendale StroGt TO 76 IN 4M- Livonia, PSI M60 (397)579-2559 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT I' QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 42 A2 9 Each latex gloves4r� l�b` ota�l: � r'r'j P�� Send Invoice To: C 01 Polico D®poKmont , Attn: Pat Young 3 Civic Squam Catrmel, IN 49M- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT f„AMOUNT Carmel Police Dept. PAYMENT Sts • A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT TH RE IS AN UNOBLIGATED BALANCE IN THIS APPROPIRIATIotLPUF,CSHIP REPAID. IENTTO PAY FOR THEABOVE ORDER. C.O.D.SHIPMENTS CANNOT BE ACCEPTED. I` PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY `Ahlof SHIPPING LABELS. oYy Policia •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 3 2 2 5 1 A.P.V. COPY-SIGN'AND RETURN TO CLERK'S OFFICE VOUCHERVVARRANTNO�___- ALLOWED 20___ |NTHE SUM OF$ �^ ONACCOUNT{]FAPPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#MTLE AMOUNT - DEPT.# | hereby certify that the attached invoice(o). nr bill(s) is (are) true and correct and that the materials orservices itemized thereon for which charge iamade were ordered and . reca1vndexoep1.______________ ` . ' ` 20____ � � _-............- . _-__-____-____'_—______ . Signature ' 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)) 01/05/15 124798 latex gloves $552.95 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 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Sunshine Medical Supply, Inc. IN SUM OF $ 31575 Glendale Street Livonia, MI 48150 $552.95 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members Encumbered I hereby certify that the attached invoice(s), or 32251 124798 42-390.12 $552.95 bill(s) is (are) true and correct and that the materials or services itemized thereon for / which charge is made were ordered and C . received except Wednesd y, ecember 31, 2014 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund