251501 11/18/15 a ter_C49M
q-' F, CITY OF CARMEL, INDIANA VENDOR: 365720
® it ONE CIVIC SQUARE COVITA CHECK AMOUNT: $*******101.33*
}. ?� CARMEL, INDIANA 46032 30 WASHINGTON AVE SUITE D CHECK NUMBER: 251501
�.y�i>ixi c�. • HADDONFIELD NJ 08033 CHECK DATE: 11/18/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 V6313 101.33 OTHER EXPENSES
� 1
coVita
30 Washington Ave,Suite D •
Haddonfield, 08033 C O 1 1
(800)707-57511
service@covita.net breath analysis is the new blood test
www.covita.net
O\V/ O I ^(V E INVOICE# V6313
DATE 11/09/2015
DUE DATE 12/09/2015
TERMS Net 30
BILL TO SHIP TO
City Of Carmel James Spelbring
elbrin 16233 Howden Drive
Attn: James S
P g Westfield, IN 46074 USA
1 Civic Square
Carmel IN 46032 USA
Please detach top portion and return with your payment.
-------------—-----------—----- --------------------.....................-------------------------------------- --------------- -------—-----------------...-
SHIP DATE SHIP VIA TRACKING NO. CUSTOMER P.O.
11/09/2015 UPS 1Z74X7090354946506 33153
DESCRIPTION _ QTY RATE AMOUNT
Steribreath-M P 2 37.50 75.00
Steribreath Mouthpieces-Box of 250
M-D-PIECE/T-PIECE--NOTE** 0 0.00 0.00
**How is your D-Piece/T-Piece Supply?" D-Pieces/T-Pieces must be replaced every
30 days,regardless of use,or if before 30 days it appears to be visibly soiled. This is
for infection control purposes.**
M-ALCOHOL VOC NOTE 0 0.00 0.00
****NEVER USE or STORE cleansing products containing alcohol around your
monitor. Use only approved coVita alcohol free wipes and alcohol free hand
sanitizers.****
M-VALUE-**NOTE"* 0 0.00 0.00
**coVita values and appreciates our relationship. Please remember that coVita
provides all sales,service and support from our offices in the USA. Thank you for your
business.-
-----------------------I------------------------------------- .............................................
usiness.***-----------------------------------------------------------------------------------------------------------_......--------------------------------------.................
Shipping&Handling Charges(may include haz-mat). SUBTOTAL 75.00
NOTE:This invoice,and the contents of the shipment associated with it will SHIPPING 26.33
be presumed correct unless client contacts us within 5 days of the receipt of TOTAL 101.33
the shipment. Please inspect your shipment immediately. BALANCE DUE
$101 .33
Federal Tax ID#:27-2887698
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
11/09/15 I V6313I Steribreath mouthpieces I $101.33
301 301
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
COVITA
30 WASHINGTON AVE SUITE D
IN SUM OF $
HADDONFIELD, NJ 08033
$101.33
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
V6313 110-100.00 j $101.33 1 hereby certify that the attached invoice(s), or
301 I ' 301
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
Monday, November 16, 2015
Cost distribution ledger classification if
claim paid motor vehicle highway fund