241401 01/22/15 1 ,f CITY OF CARMEL, INDIANA VENDOR: 343500
ONE CIVIC SQUARE ZEE MEDICAL, INC. CHECK AMOUNT: $****"**234.60*
x CARMEL, INDIANA 46032 PO BOX 204683 CHECK NUMBER: 241401
DALLAS TX 75320 CHECK DATE: 01/22/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239012 0158680117 234.60 SAFETY SUPPLIES
ZEiE
INVOICE
ZEE MEDICAL INC. PAGE 1
P.O. BOX 204683 DATE 0111512015
DALLAS TX 75320 TIME 14:35:05
877-275-4933
JOE WEBSTER ext509 09!009!19 ORDERIINVOICE# 0158680117
Alt: ! 1 P.0,#
BILL TO # M00486 SHIP TO# 000486
CARMEL STREET DEPT CARMEL STREET DEPT
3400 WEST 131ST STREET 3400 WEST 131ST STREET
Westfield IN 46074 Westfield IN 46074
317-733-2001 317-733-2001
AMY LUNN
PART # QTY DESCRIPTION $PRICE $EXTENDED TAX
------ --- ----------- ------ --------- ---
0797 1 QR WOUND SEAL WITH APPLICATOR, 2/PK 18.80 18.80 N
1495 1 HISTENOL FORTE 11, 1001BX 23.80 23.80 N
1405 1 PA BACK RELIEF FORMULA- 1001BX 19.15 19.15 N
LOCATION# 1 LOCATION DESCRIPTION - MAINTENANCE SUBTOTAL: 61.75
2629 1 EYE WASH, STERILE 1 OZ, 2/UNIT 11.70 11.70 N
0740 1 BNDG-NON-LTX ELASTIC STRIP, 50lBX 8.50 8.50 N
0743 1 BNDG-NON-LTX LG PATCH, 25113X 10.20 10.20 N
0716 1 BNDG-NON-LTX KNUCKLE, 40113X 10.75 10.75 N
0920 1 GAUZE PAD-31N X 31N, 101BX (ZEE) 5.30 5.30 N
1801 1 3-ANTIBIOTIC DINT 0.9 GM 25113X (ZEE) 10.50 10.50 N
1817 1 HYDRO CREAM 1.0%, 0.9 GM 251BX (ZEE) 11.70 11.70 N
0305 1 TAPE, 21N X 5 YD. 3 CUT SPOOL (ZEE) 6.90 6.90 N
LOCATION# 2 LOCATION DESCRIPTION - MAIN BLD MENS R SUBTOTAL: 75.55
1421 1 IBUTAB 2501BX (ZEE) 35.95 35.95 N
1418 1 PAIN-AID 250lBX (ZEE) 30.60 30.60 N
1495 1 HISTENOL FORTE 11, 1001BX 23.80 23.80 N
9900 1 HANDLING 6.95 6.95 N
LOCATION# 3 LOCATION DESCRIPTION - MAIN BLD BREAKR SUBTOTAL: 97.30
INVOICE
ZEE MEDICAL INC. PAGE 2
P.O. BOX 204683 DATE 0111512015
DALLAS TX 75320 TIME 14:35:05
877-275-4933
JOE WEBSTER ext509 091009119 ORDERIINVOICE# 0158680117
Alt: ! 1 P.O.#
PART # QTY DESCRIPTION $PRICE $EXTENDED TAX
------ --- ----------- ------ --------- ---
SAFETY: .00
FIRST AID: 234.60
NONTAXABLE: 234.60
TAXABLE: .00
SUBTOTAL: 234.60
TAX 1: .00
TAX 2: ,00
TOTAL 234.60
SIGNATURE _ DATE:
PRINT NAME: -- ---------- -- - TITLE: ------ ---
ASK US ABOUT FIRST AID AND AED PROGRAMS
THANK YOU FOR YOUR BUSINESS!!
INVOICE IS CONFIDENTIAL MAY BE SUBJECT TO LATE FEES
VOUCHER NO. WARRANT NO.
Zee Medical ALLOWED 20
IN SUM OF$
P.O. Box 204683
Dallas, TX 75320
$234.60
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 I 0158680117 I 42-390.12 I $234.60 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
1 V
�f dayJa uat�'015
t%
Street Commissioner
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))
01/15/15 0158680117 $234.60
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