HomeMy WebLinkAbout180926 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 242000 Page 1 of 1
ONE CIVIC SQUARE PHYSIO CONTROL CORP
a 1 CARMEL INDIANA 46032 12100 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $1,038.00
CHICA IL 60693
CHECK NUMBER: 180926
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 PH686231 768.00 EMS EQUIP
102 4467006 PH686637 270.00 EMS EQUIP
DATE SHIPPED PURCHASE ORDER NUMBER SALES /SERVICE REPRESENTATIVE sii?xiA7ilALL•s r_• IEIY1_IEFr
`:2f4 <i2%i`_cii
12/04/09 Mark CSPPP1 EALL71 qxi 1003120155002/mj
CARRIER CARRIER TRACKING NUMBER SALES ORDER 1 PAYMENT TERMS 1
WSGRD 0345741283 CNT 1 S2862237 -00 Net 30 Days
:a
'I'. �(t�:::: Q�� Q: UN E1' F >:1�1:
I. 1. 11:996 Filterl Sett
Adult /Pediatric
includes airway adapter
I 1
.::2 1T.9:96- :0000x.7
QULK- COMBO.W /REDI PAK TZ: EA 12 0 42 0:0 5.04::00 E
I 1 ELECTRODES
1
L /C: 929601 Expires: 04/2 /12 ..2
Contact: MARK HULETT
I Phone: 317 -!571 -2663
Sub Total 744.00
Frei•It and Handling 24.00
(THIS PRODUCT` IS TO A CONSENT DECREE 'OF PE °1 I E JUNCTION;' FILE
IN:UNITED STATES U MEDT INC :AND ,PHY CO TRoL, IN .ET[ AL., 3
�CIV� NO C08 064 tW D WASH 2008) UNDER HE TE I S: OF T1- CON E NT DE
_fC HE SALE CP..DIST OF THI PRODU AUTHO IZ IN IM
IRCUMSTANCES TO MEET T HE ::SPECI .AND IMMEI'IATE NEE OF �A
INDIVIDU AND..ORU THE R ES2RIC CONS HE Sly E OP. ID I S IRIBUTI �O N
OF: PRO .WILL >BE REMOVED WHEN PHYSIO CONTR L; INC �S SATISFIED FDA
THAT ITS FACILITIES, METHODS :PROCESSES, ANIP CONT OL >RELA< ED TO THE
MANUFACTURE:: AND QUALITY OF
THE PRODUCT ARE N CON OR ITY WITH THE QUALITY '`3
SYSTEM REGULATION, 21 C F :R 'PART :.8 AND T: E TER S 'o.F. THE; CONSENT DECREE
768.00 1
Site: 20
0 R I G I N A L
V� master
ACCEPTED
NOTE: TERMS CONTAfNED ON THE REVERSE SIDE OF THIS DOCUMENT ARE EXPRESSLY MADE A PART OF THIS SALES AGREEMENT AND ARE INCORPORATED HEREIN.
DATE SHIPPED PURCHASE ORDER NUMBER SALES /SERVICE REPRESENTAT VE jt ?3?;'jyKAP.j;.,i; Sze;(h7MEF,;i
12/07/09 Mark CSPPP1 EALL71 qxi 003120155002/mj
CARRIER CARRIER TRACKING NUMBER SALES ORDER PAYMENT TERMS
WSGRD I 0344403060 CNT 1 S2848564-00 Net 30 Days
`L Vii, 0 0tV9. tilt0 A ROSO{ OO }l•04 F. t,fgA #F.,
1 11171 000 018; LNCS.'WDCI PEDIATRIC SPO2 3> EA 1 0 ..270.00 270:00 1<i
SENSOR REUSABLE
L /C: 09MNU 1 MA
ml
Contact: MARK HULETT
Phone: 317 -571 -2663
Sub Total 270.00
THIS PRODUCT I5 S I U BJECT TO A CO N D EE >OF PE'I E NT —1. JUNCTION. FILED
EIN.' UNITED STATES V. MEDTRONIC I NC. A ND' PHY I O CO TRoPL INo. ET AL.
E CIV NO C08 -0649 L(W.,El WASH 2;008) UNDER T HE TE'I S OF THE CONSENT DECREE
THE SALE OR:DISTRIIBUTION OF THIS PRODUCT IS AUHO Z D
T I IN IMT
ID
C IRCUMSTAN C E S T O<ME E T THE SPEC AND IMM EE S OF RTI
INIJIVIOUALS AND ORGANIZATI THEE RESTRICTIONS 0 HE: SA E.. ..OT Z: DISTRIBUTION
OF TH PRODUCT. WILL BE :REMOVED .WHEN PHYSIO CONTR:eL INC .HAAS SATISFIED :FDA
I I
T HAT ITS FACILITIES M
O, PRO A C O OL
N T TO. THE
MANUFACTURE:: AND QUALITY OF TH PRODUCT.ARE IN CON OR ITY.WITH TH QUAL
gYS'T 2 1: C F R P ART 8 2 0.: AND T E TER 6S F THE C ON S ENT DECREE
270.00
Site: 20
OR I G I N A L
VISA IVtaster
ACCEPTED
NOTE: TERMS CONTAINED ON THE REVERSE SIDE OF THIS DOCUMENT ARE EXPRESSLY MADE A PART OF THIS SALES AGREEMENT AND ARE INCORPORATED HEREIN.
VOUCHER NO.. WARRANT NO.
ALLOWED 20
Physic Control
IN SUM OF
12100 Collections Center Drive
Chicago, IL 60693
$1,038.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #TTITLE AMOUNT Board Members
1120 PH686637 102- 670.06 $270.00 I hereby certify that the attached invoice(s), or
1120 PH686231 102 670.06 $768.00 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
1 2009
4 41-1 U g
n
[J t
1
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)
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))
PH686637 $270.00
PH686231 $768.00
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
Clerk Treasurer