303506 09/26/16 CITY OF CARMEL, INDIANA VENDOR: 368918
® 4; ONE CIVIC SQUARE PENN CARE INC. CHECK AMOUNT: $*****2,691.50*
r. CARMEL, INDIANA 46032 1317 NORTH ROAD CHECK NUMBER: 303506
v�'IroN�°a, NILES OH 44446 CHECK DATE: 09/26/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 93042 1,944.60 SPECIAL DEPT SUPPLIES
102 4239011 93075 315.00 SPECIAL DEPT SUPPLIES
102 4239011 93128 259.90 SPECIAL DEPT SUPPLIES
102 4239011 93310 172.00 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
PENN CARE INC. ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
1317 NORTH ROAD IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
NILES, OH 44446 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$2,519.50 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
93042 42-390.11 $1,944.60 1 hereby certify that the attached invoice(s),or 9/15/16 93075 $315.00
1120 10 1120 102
93075 42-390.11 $315.00 bill(s)is(are)true and correct and that the 9/15/16 93128 $259.90
1120 _0_2 materials or services itemized thereon for 1120 102
93128 I 42-390.11 I $259.90 9/15/16 I 93042 I I $1,944.60
1120 (102_-) which charge is made were ordered and 1120 102
received except
Thursday, September 15,2016
David Haboush
Fire Chief
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
, 20-
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Invoice #93075
1317 North Road PO:
Niles, OH 44446
{ ®� 800-392-7233 Order Date: 8/18/2016
Public Safety Technology sales@penncare.net Invoice Date: 9/2/2016
Terms: Net 30
Ship Method: UPS Ground
Sill To: Ship To:
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square.
Carmel, IN 46032 Carmel, IN 46032
Carmel Fire Department
5 5 0 PC-1057221 Flow-Safe II CPAP with Large Adult 63.00 each 315.00
Mask with Nebulizer, Tee
$315.00
Subtotal $315.00
Shipping
Tax-@
TOTAL $315.00
Payments
Credits
Page 1 of 1
Invoice x#93042
1317 North Road
Niles, OH 44446 PO'
- � OEM; ti 800-392-7233 Order Date: 9/1/2016
Public Safety Technology sales@penncare.net Invoice Date: 9/1/2016
Terms: Net 30
Ship Method: UPS Ground
Sill To: Ship To:
Carmel Fire Department Carmel Fire Department
2 Civic Square 540 W 136 Street
Carmel, IN 46032 Carmel, IN 46032
Carmel Fire Department
100 100 0 MF-296L Gloves, MidKnight Nitrile, L, 100/box 10.62 each 1,062.00 -/
36 36 0 3M-1582 Coban Self Adherent Wrap, 2" x 5yds, 2.45 each 88.20 -/
Tan
12 12 0 MD-MSPLINT Splint, Flex-All, Orange (SAM SPLINT) 6.00 each 72.00
30 30 0 LA-980010 Collar, Stifneck Select, Adult 8.50 each 255.00 -/
30 30 0 LA-980020 Collar, Stifneck Select, Pediatric 8.50 each 255.00 -/
20 20 0 MF-296S Gloves, MidKnight Nitrile, S, 100/box 10.62 each 212.40 -V
$1,944.60
Subtotal $1,944.60
Shipping
Tax @
TOTAL $1,944.60
Payments
Credits
Page 1 of 1
Invoice #93128
1317 North Road
Niles, OH 44446 Order Date: 9/6/2016
800-392-7233
Public Safety Technology sales@penncare.net Invoice Date: 9/6/2016
Terms: Net 30
Ship Method: UPS Ground
Sill To: Ship To:
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
Carmel Fire Department
10 10 0 GF-51926 MegaMover Portable Transport Unit, 25.99 each 259.90
White/Black, 40"x 80"
$259.90
Subtotal $259.90
Shipping
Tax
TOTAL $259.90
Payments
Credits
77
77
Page 1 of 1
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
PENN CARE INC. ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
1317 NORTH ROAD IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
NILES, OH 44446 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$172.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
93310 42-390.11 $172.00 1 hereby certify that the attached invoice(s),or 9/21/16 93310 $172.00
1120 (102 1120 102
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
Wednesday, September 21,2016
David Haboush
Fire Chief
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
,20—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Invoice #93310
1317 North Road
Niles, OH 44446 PO:
in
>z �� 800-392-7233 Order Date: 9/14/2016
Many Needs...One Solution sales@penncare.net Invoice Date: 9/14/2016
Terms: Net 30
Ship Method: UPS Ground
Bill To: Ship To:
Carmel Fire Department Carmel Fire Department
2 Civic Square 540 W 136 Street
Carmel, IN 46032 Carmel, IN 46032
-
Carmel Fire Department
20 20 0 MD-SH EMS Rescue Trauma Shears, Black 2.50 each 50.00
20 20 0 MD-MSTR140 Triangular Bandage 0.30 each 6.00
20 20 0 SM-9021282. ET Tube Introducer, Bougie-To-Go, 5.80 each 116.00
15FR X 60cm
$172.00
Subtotal $172.00
Shipping
Tax @
TOTAL $172.00
Payments
Credits
Page 1 of 1