319026 11/22/17 Gqq
CITY OF CARMEL, INDIANA VENDOR: 368918
�.( d ,•; ONE CIVIC SQUARE PENN CARE INC.
CHECK AMOUNT: $*****1,607.05*
a� CARMEL, INDIANA 46032 1317 NORTH ROAD CHECK NUMBER: 319026
NILES OH 44446 CHECK DATE: 11/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER _ AMOUNT DESCRIPTION
1120 4239011 M11785 1,580.50 SPECIAL DEPT SUPPLIES
1120 4239011 M1178501 26.55 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20
Vendor# 368918 ACCOUNTS PAYABLE VOUCHER
PENN CARE INC. IN SUM OF$ CITY OF CARMEL
1317 NORTH ROAD 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.
NILES, OH 44446
Payee
$1,607.05
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
M11785 42-390.11 $1,580.50 1 hereby certify that the attached invoice(s),or 11/15/17 M11785 $1,580.50
1120 102 1120 102
M11785.01 42-390.11 $26.55 bill(s)is(are)true and correct and that the 11/15/17 M11785.01 $26.55
1120 102 materials or services itemized thereon for 1120 102
which charge is made were ordered and
received except
Thursday, November 16,2017
David Haboush
Fire Chief -
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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
1 /
JWWML Invoice #M11785.01
1317 North Road
Niles, OH 44446
(800)392-7233
iM Many Needs....One.Solution sales@penncare.net
Bill To: Ship To: Order M M11785
Carmel Fire Dept. Carmel Fire Dept. PO: TomPayne
Attn: Tom Payne Attn: Tom Payne Internet Order#: 109712
2 Civic Square 2 Civic Square Terms: Net 30
Carmel, IN 46032 Carmel, IN 46032 Order Date: 11/13/2017
Invoice Date: 11/15/2017
Ship Via: UPS Ground
Code - Prloo. • -
10-30000 Sharps; Dart (Shuttle) Container 2.95 9 each 26.55
Tracking # 1Z4760184399238417 Subtotal $26.55
Shipping $0.00
Tota 1 $26.55
Payments/Credits
1
Pagel of Printed: 11/15/2017 at 12:44:58 PM
1317 North Road Invoice #M11785-
� �� A Niles, 44446
(800)39292-7233
Many Needs....One Solution sales@penncare.net
Bill To: Ship To: Order#: M11785
Carmel Fire Dept. Carmel Fire Dept. PO: TomPayne
Attn: Tom Payne Attn: Tom Payne Internet Order#: 109712
2 Civic Square 2 Civic Square Terms: Net 30
Carmel, IN 46032 Carmel, IN 46032 Order Date: 11/13/2017
Invoice Date: 11/13/2017
Ship Via: UPS Ground
'Code Name Price Qty Unit Ext Price
01-361905 i-Gel Supraglottic Airway Size 5.0 for' 22.00 4 each 88.00
Large Adults(200+lbs.)
09-0493T Splint, Flex-All, (SAM SPLINT)Orange 6.00 12 each 72.00
10-30000 Sharps, Dart (Shuttle)Container 2.95 16 each 47.20
01-361903 i-Gel Supraglottic Airway Size 3.0 for 22.00 2 case 44.00
Small Adults(65-130lbs.)
01-361904 i-Gel Supraglottic Airway Size 4.0 for. 22.00 1 each 22.00
Medium Adults(110-200lbs.)
09-0449A Collar, Ambu Perfit ACE Adjustable 5.75 90 each 517.50
Adult
02-028404 Syringe, Luer-Lok, BD 1Occ 0.35 100 each 35.00
01-37433 Nebulizer, Hand Held 0.80 50 each 40.00
02-13383 IV Start Kit,with Site-Loc, 8" 4.00 100 each 400.00
Extension, Pre-Filled 1 Occ Syringe
12-36252 Patient Mover 80"x 40" 25.00 7 each 175.00
03-03113 Electrodes, QUIK-COMBO Connectors 34.95 4 pair 139.80
Pedi Edge RTS
Tracking # iZ4760184390458624 Subtotal $1,580.50
Shipping $0.00
Total $1,580.50
Payments/Credits
Balance $1,580.50
Page 1 of Printed: 11/13/2017 at 11:04:36 AM