183494 03/16/2010 CITY OF CARMEL, INDIANA VENDOR. 362454 Page 1 of 1
0 ONE CIVIC SQUARE VERATHON
CHECK AMOUNT: $15,230.00
CARMEL, INDIANA 46032 20001 NORTH CREEK PARKWAY
BOTHELL WA 98011 CHECK NUMBER: 183494
CHECK DATE: 3116/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 12749 223864 15,230.00 GLTDESCOPE
VERATHON5
Invoice Purchase Order
12749
Invoice 223864
Remit to: Date: 2/25/10 Sales Order SLS221534
Verathon, Inc. Order Date: 2/24/10 Customer 1046326
16542 Collections Center Drive Ship Date: 2/25/10 Terms: Net 45 Days
Chicago, IL 60693
United States Ship Via Ground
Packlist 232139 Formerly Diagnostic Ultrasound
800- 331 23131425- 867 -1348
425 883 -2896 Fax
Bill To Ship To
City of Carmel Fire Department City of Carmel Fire Department
Attn: Accounts Payable 2 Civic Sq
2 Civic Sq Carmel, IN 46032 -2584
Carmel, IN 46032 -2584 United States
United States
Part Descripti /Serial Number(s) Sh Qty Unit Price Amount
0270 -0415 GlideScope® Ranger Sys Single Use, NA 1 9,334.00 9,334.00 USD
RV092880
0570 -0198 Ranger Video Baton 3 -4 1 0.00 0.00 USD
RB092504
0270 -0607 GlideScope® Ranger Video Baton 1 -2 Kit 1 5,896.00 5,896.00 USD
RP091658
0900 -1455 Training Pack, GlideScope® Ranger EN 1 0.00 0.00 USD
0001 -0001 Freight 1 0.00 0.00 USD
SALESTAX 1 0..00 0.00 USD
Sub Total $15,230.00
Tax 0.00
Freight 0.00
Payments 0.00
Grand Total $15,230.00
USD
VOUCHER NO. WARRANT NO.
ALLOWED 20
Verathon
IN SUM OF
20001 North Creek Parkway
Bothell, WA 98011
$15,230.0
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
AO Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
12749 223864 102- 670.06 $15,230.00 I hereby certify that the attached invoice(s), or
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
R 1- 2010
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))
223864 $15,230.00
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