HomeMy WebLinkAbout112828 WILLIAM NASSER MD HEALTHCARE ED
City of Carmel
EachEachEachEachEachEachEachEachEachEachEachSub Total
Department:Account:Fund:
11111111111Administration FeesTray Rental Nasser Minor SurgicalTray Rental Chest AccessPorcine modified pluck - Up to 20 @ 2.75 ea.Original Contract Signed and Dated 4-11-24One Anatomy
Lab Station with small debrief roomNon-Transplantable Anatomic DonorApplied DiscountsAnatomy Lab Tech to AssistAnatomy Lab Station AdderAnatomy Lab Cleaning Fee($2,587.50)$1,000.00$1,160.00$4,300.00
$419.00$225.00$150.00$680.00$250.00$55.00$0.00Page 1 of 1($2,587.50)$1,000.00$1,160.00$4,300.00$5,651.50$419.00$225.00$150.00$680.00$250.00$55.00$0.00
112043-570.03101General Fund
INDIANA RETAIL TAX EXEMPT
Send Invoice To:
CERTIFICATE NO. 003120155 002 0PURCHASE ORDER NUMBER
Carmel Fire Department
112828
Accounts Payable
FEDERAL EXCISE TAX EXEMPT
35-6000972
210 Veterans Way
THIS NUMBER MUST APPEAR ON INVOICES, A/P
ONE CIVIC SQUARE
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
CARMEL, INDIANA 46032-2584
Carmel, IN 46032-
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
PLEASE INVOICE IN DUPLICATE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTIONDEPARTMENTACCOUNTPROJECTPROJECT
ACCOUNTAMOUNT
Cadaver Lab - 2nd Class
$5,651.50
PAYMENT
10/29/2024365641
* A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
WILLIAM K NASSER MD HEALTHCARE ED Carmel Fire Department
*SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
VENDORSHIP
250 W 96TH STREET 4TH FLOOR 210 Veterans Way
*C.O.D. SHIPMENT CANNOT BE ACCEPTED.THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
TO
*PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
ATT: DIANA VANCAUWENBERGH Carmel, IN 46032-
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
INDIANAPOLIS, IN 46260 -
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS
FREIGHT
Denise SnyderZac Jackson
TITLE
92656Accreditation/Budget AdministratorCFO
112828
CONTROL NO.
QUANTITYUNIT OF MEASUREDESCRIPTIONUNIT PRICEEXTENSION