155275 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00351190 Page 1 of 1
0 ONE CIVIC SQUARE E M P CHECK AMOUNT: $851.80
CARMEL. INDIANA 46032 1711 PARAMOUNT COURT
WAUKESHA WI 53186 CHECK NUMBER: 155275
CHECK DATE: 111 012 0 0 8
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 1016937 851..80 SPECIAL DEPT SUPPLIES
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INVOICE
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Ph: 800- 558 -6270 www.BuYEMP.com Ph: 866-558-0686 www.schoolkidshealtheare.com
Bill to: City of Carmel Fire Dept. Ship to: Carmel Fire Dept.
Mark Hulett Mark Hulett
2 Carmel Civic Sq. 10701 N. College
Carmel, IN 46032 Indianapolis, IN 46280
Date Page
Thank you for your order! 12/21/2007 1 of 1
PO Number Customer No. Shipping Method Payment Terms INVOICE NUMBER
Mark -1 -2008 1741 UPS DEST_ Net 30 Days IN 0-16937
Item Number Description ordered Shipped B/O U of M Unit Price Ext Price
00128 LUBRICATING JELLY FOIL PACKETS 2.7GRAMS 144/BOX 1 1 0 BOX $8,95 $8.95
103003 STYLETTE FOR ET TUBE SIZES 5.0MM 10.OMM, 12FR 1 1 0 BOX $47.35 $47.35
980010 LAERDAL STIFNECK SELECT ADJUSTABLE C- COLLAR, ADULT 1 1 0 CASE $374.50 $374.50
S510SHC PYRAMEX SAFETY GLASSES OVER THE GLASSES MODEL 25 25 0 EACH $2.29 $57.25
CSE8TS1- B.BRAUN ULTRASITE T- PORT STAND. BORE EXT SET 1 1 0 CASE $363.75 $363.75
Subtotal Handling Fee Freight Trade Disc. Sales Tax Total
$851.80 $0.00 $0.00 $0.00 $0.00 $851.80
Remit To: 1711 Paramount Court, Waukesha WI 53186
Fax 800- 558 -1551
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))
Total
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
gym@ IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT, 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
t r—
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund