244805 04/29/15 v! CITY OF CARMEL, INDIANA VENDOR: 360209
°l ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $*****1,930.61*
CARMEL, INDIANA 46032 ATTN:CAROLYN TERRY ACCT.RPTNG CHECK NUMBER: 244805
10330 N MERIDIAN ST SUITE 430 CHECK DATE: 04/29/15
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 13543 1,930.61 SPECIAL DEPT SUPPLIES
St. Vincent Hosp & Healthcare Center, Inc. It1VO1C@
Attn: Katreena Shirey Acct Rptg
10330 N. Meridian St., Suite 430 North DATE INVOICE#
Indianapolis, IN 46290-1024 4/27/2015 13543
BILL TO
Carmel Fire EMS
Attn: Denise Snyder
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased through April 22, 2015 1,930.61
Total $19930.61
Inquiries: Katreena Shirey Payments/Credits $0.00
317.583-3324
katreena.shirey@stvincent.org [Balance Due $19930.61
Depatmental Transfer of Supplies date submissed
Requesting Department: Carmel Fire Dept Supplying Department ER
Cost Center Cost Center '4602431600
QUANTITY UNIT COST TOTAL COST
Alcohol preps 1 $1.96 $1.96
Angiocath 16g 8 $1.50 $12.00
Angiocath 18g 47 $1.50 $70.50
Ari iocath 20g 122 $1.50 $183.00
Angiocath 20g 1.88 per box $95.00 $0.00
Angiocath 22g 20 $1.50 $30.00
Angiocath 24 $1.55 $0.00
A uasonic Gel (per box 2 $13.12 $26.24
Bandaids 30 $0.05 $1.50
Basin kidney shaped $0.08 $0.00
Basin round $0.31 $0.00
Ca no- Line Sampling ETCO2 Smart Ped per bx $287.50 $0.00
Ca no-Circuit Nasal with Tubing Adult per cs 1 $312.50 $312.50
Ca no-St filter lin Adlt/ ed 1 case $204.00 $0.00
Coban 1' Roll ea $1.75 $0.00
Cold paks -- - $0.57 $0.00
EKG Electrodes $3.12 $0.00
Emesis Bas(perpack) 4 $11.52 $46.08
EZ-10 Adult Needles $495.00/box of 5 $99.00 $0.00
Foam -Quikcare $2.67 $0.00
Guaze, 2 x 2 Cotton bail $1.88 $0.00
Guaze, 2 X 2 Sterile 101 $0.02 $2.02
Gauze 4 X 3 sponge (per box $1.24 $0.00
Gauze 4 x 4 tub 25 $0.32 $8.00
Gauze Kerlex 19 $0.67 $12.73
Gloves-Med $10.35 $0.00
Gloves- Large $10.35 $0.00
Gloves-Xlar a $10.35 $0.00
IV Adapter, Luerlock 28 $0.15 $4.20
IV Dial a flow $3.15 $0.00
IV Extension 19" $1.911 $0.00
IV Lock with Ext 75 $1.87 $140.25
IV Start Kits ea 107 $2.88 $308.16
IV Start Kits Sobraview 100/bx 2 $2.66 $5.32
IV Tubing 15 tt 18 $1.17 $21.06
Kerlix 4.5"x6ply $0.73 $0.00
Lancets 200 $1.21 $242.00
Largyngscope Blades Stat 3-box $180.50 $0.00 -
Largyngscope Blades Stat 4 box $135.74 $0.00
Microdot Xtra Test Strips $24.95 $0.00
Microdot Xtra Control Solutions $12.00 $0.00
Normal Saline 1000 cc bags/ca $9.48 $0.00
Razor, dis oseable 10 $0.12 $1.20
Sca el#11 $1.30 $0.00
Sharps Container $4.59 $0.00
Sterile H2O bottle $0.71 $0.00
Suction Canister&to $3.26 $0.00
Suture Kit 1 $1.09 $0.00
Syringe w/Needle 1 ml $0.07 $0.00
Syringe w/Needle 3 ml 33 $0.05 $1.65
Syringe w/Needle 5ml 32 $0.10 $3.20
Syringe w/Needle 10 ml 48 $0.12 $5.76
Syringe w Saline 3ml $0.28 $0.00
Syringe w/Saline10ml $0.32 $0.00
10 ml saline vials (per box 3 $9.63 $28.89
Tape 2" 6 rolls/box 10 $1.00 $10.00
Tae 1" 11 $0.50 $5.50
Tape 2"cloth adh 13 $1.29 $16.77
Tape Trans ore 1/2" $1.28 $0.00
TB ET Cuffed Rediture $1.80 $0.00
Warm paks $1.46 $0.00
Wound Cleanser $5.04 $0.00 !
Suction Canister&to $3.26 $0.00
Yankauers $0.34 $0.00
Ambu Ba w/mask-Adult $14.63 $0.00
Ambu Ba w/mask-Adult cs/10 2 $146.30 $292.60
Ambu Ba w/mask- Peds cs/10 1 $126.00 $126.00
Ambu Ba w/mask- Infant cs/10 $16.00 $0.00
CPAP mask- 1 case/10 $919.99 $0.00
Lg Bitrac Full Face Mask $29.00 $0.00
ET Tube Stylette $0.00
Wi es Disenfect 1 $11.52 $11.52
Grand Total $1,930.61
Approved by date
VOUCHER NO. WARRANT NO.
St. Vincent Hospital $b ALLOWED 20
I'I Attn: Carolyn Terry, Acct. Reporting IN SUM OF$
10330 N. Meridian Street, Ste. 430 N
Indianapolis, IN 46290
$1,930.61
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 13543 102-390.11 $1,930.61 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
nC99�
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
I 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))
13543 $1,930.61
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
120
Clerk-Treasurer