The URL can be used to link to this page

Home My WebLink About201245 09/13/2011 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC i CHECK AMOUNT: $2,258.29 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055 -0241 CHECK NUMBER: 201245 CHECK DATE: 9/13/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 1008973 -01 11.69 SPECIAL DEPT SUPPLIES 102 4239011 2081646 -01 43.84 SPECIAL DEPT SUPPLIES 102 4467006 2864133 -01 717.00 EMS EQUIP 102 4239011 2872739 -01 495.76 SPECIAL DEPT SUPPLIES 102 4239011 8907551 -01 990.00 SPECIAL DEPT SUPPLIES HSI. ORDER ORDER DATE` 'DUE DATE 94113307 08/31/11 09/30/11 WHSE DEA# RHO162494 Fed ID: 11- 3136595 a gmg a �.t, as :'v,: cl O® b,. £N T his order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23:00304 1 496 -6428 100 /BX LANCET SURGILANCE GRAY 23G 1.8 4 4 10.96 43.84 1 F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S sRVICES, RECEIVABLE OR REDEEMABLE N ACCO ZDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEI VING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER.PAYER MAY REQUEST INFORMATION REGARDING SUCH V kLUE, D UPON ANY SUCH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSq THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THESE RECORDS. MERCHANDI E TOTAL 43.84 Invoice Date 30 days 43.84 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: HENRY SCHEI INC. DEPT CH 102 1 ALATINE, I 60055 -0241 BILL TO HIPTO INVOICE lf ::INVOI ITEM STATUS KEY REM KEY 1308571 1817102 2081646-01 43.84 11- Backordered; Item will follow SK School Kit HSI ORDEIZ4 ORDER IDA T I NV E I I ATE g D Discontinued; Item no longer available NC -No Charge F Special Schein Free Goods M Manufacturer will ship Item directly to you 94113307 0 8 31 11 8/31/11 1 P Prescription Drug; Return Authomation Required ST MER PO pA R Refrigerated Item: May be shipped separately Special Schein Pricing MARK 1 OF 1 T- Taxable It unavailable: please reorder LP300 �_avment Terms. We make overvaffo! tomainta:n durai:ori of Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, natabg.huwova�wnmnemethe riallft to make Price adjustments |n VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' ohoechances Guaranteed Satisfaction: or Kyou have hiadaDmduct and i(iodofociveurdnoonutpedu,m Bill Your Order o Y_ Open Account ooUu/odnri|y will provide a credit, ref und.nrexnhungej[oynur Available to licensed practifionor in the US. N':nvoil are choice. Simply :a||our cus(umer service department w"hi 3O day o payable within 30 days. receipt of|hoommhoodiaotoxrmo0eiu/ the m!um. For vmrran�mp� m ruri�yo:wmoe�oome�ingyoudidn�o�a� oimp|yoa|\� Rx Products Controlled Substances: M8tKx Medical 1~800~845'3550 Rogo|a1|onorequiroxoto limit the na|eojRx and non(m|!ed substances only tom0istered.|iounund healthcare Professionals. Uyou are o new nuatwero/ have recently d please furnish substances, fiurnish a copy of your DEA certificate, verifying shipping address. Class 11 drugs can be ordered only by mail, International Orders: Please Note: We proudly serve healthcare professionals andgmmmmonb Openedhandp�cnx and equipment may not bnr�:madf or �h Tn� credit, place �mmand unndUiono p|�menon�o oor|��mahnn�Depa�:an�� monu�ciu�orwnrmnbeu.Bufom opening handPi*casor :-800-845-35,550 eqoipmen� we suggest ggas�\�a� h k|honh|p i container and p"y list verify you have 'received exactly what Pn8scyi�tion��ru��eiurOs Instructions: you dnmdO dC |a Software returnable. Other restrictions may also apply. ARe!umAuthnhzodnnio Required for all P h i Drugs, Sit p!ycall our "Astorner Service Department 1800-845-35% HsI ORDERq ORDER DATE DUE DATE 93926829 08/23/11 09/22/11 WHSE DEA# RH0162494 Fed ID: 1 1- 31 36595 POW W, his order aas been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic#: 23 00304 1 891 -3037 PU 50 /CA IV PREP KIT W/ TEGADERM 8 8 C 61.97 495.76 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA S "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT GAINSI THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN THEESE RECORDS. MERCHANDI E TOTAL 495.76 Invoice Date 30 days 495.76 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEIJ INC. DEPT CH 10211 ALATINE, I 60055 -0241 BILL TO SHIP TO INVOICEll INVOICE ITEM STATUS KEY REM KEY 1308571 1817102 2872739-01 4 9 5. 76 B- Backordered: Item win follow SK School Kit D Discontinued: Item no longer ar NC No Charge HSI O RDER4 ORDER DATE INVOICE DATE If OF BOXES P Special Schein Free Goods 8/23/11 M- Manufacturer will ship Item directly to you 93926829 08/23/11 P Prescription Drug: Return Authorization Required CUS TOMER PO# PA R Refrigerated Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 1 T Taxable Item LP300 t y gent t L-1 s: We make every effort to maintain prices for the duration of a payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: If you have tried a product and it is defective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; it's your ill Your Order To Your Open Account choice. Simply call our customer service department within: 30 days Available to licensed practitioners in the U.S. All invoices are of receipt of the merchandise to arrange for the return. Fora payable within 30 days. warranty repair or if you were sent something you did not order simply call: Rx Products Controlled Substances: Matrx Medical 1- 800 845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. If you are a new customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, furnish a copy of your DEA certificate verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Pleas Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but will be repaired or re laced in accordance with throughout the world. To place orders or for inquiries on export manufacturer warranties. Before opening handpieces or terms and conditions, please contact our International Department: 1-800-845-3550 equipment, we suggest that you check the shipping container and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department a 1 -800- 845 -3550. HS I ORD-]R� ORDER-DATE DUE DATE 93828917 08/18/11 0 9 /21/11 WHSEDEA# RHO162494 Fed ID: 11-3136595 1 744 EA X VALUE ZIP VEST LARGE 1 1 11.69 11.69 PRODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE MATUFACTtRER. IF YOU ARE 3 ARTICIPATING IN A DISCOUNT PROGPAJI (E.G. POINIS, GIFTS OR O SPECIAL AWAZDS ("DISCOUNT")), WITH THIS PURCHASE YOU HAVE EARNED A CREDI" TOWARD GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE N ACCOZDANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, "OU ARE RECEI OR WILL R110EIVE OTICE OF T 1E DISCOUNT VALUE. FROM TIME TO TI E, MEDICARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORRATION REGARDING SUCH V kLUE, T ND UPON ANY S JCH EQUEST, SUM VALUE MUST BE DISCLOSED AS A DI3COUNT �GAINSI THE PURCHASE3 THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE'AIN THESE RECORDS. MERCHANDI!E TOTAL 11.69 Invoice Date 30 days 11.69 PLEASE NOTE NEW REMIT TO ADDRESS Please remi- payments only to the following aidress: HENRY SCHEI4 INC. EPT CH 10211 PALATINE, 1, 60055-0241 ITEM STATUS KEY F REMVFREY 1308571 1308572 1008973-01 11.69 B Backordered: Item will follow SK School Kit MI ORDER# ORDER DATS INVOICE DA I TE 4 OF 13OXES Discontinued: Item no longer available NC No Charge Special Schein Free Goods M Manufacturer will ship Item directly to you 93828917 08/18/11 8/22/11 P prescription Drug; Return Authorization Required R Refrigerated Ircm: May be shipped separately CUSTOMER PO4 PAGE# Special Schein pricing U Temporarily unavailable; please reorder $e make oervefort �omaintu� prices for the dmafiorl of Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, oa�bg.hu�ovn�womuomo�ha phoaad�a�non�in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response |omunufacturen/phoochances Guaranteed Satisfaction: or Uvnu have t,iedaomduct and itin detective or does n0tpodu,m Bill Your Order To Your Open Account mahu(uobri|y credit, refund, nr exchange: it's your choice. Simp�ne3nurcuu�meruowinede U ��|hin30��o ayable wifin. 30 days, 0;mcoipt of [he mmnhaod|xoWanmngefo/ihem'um. For vmnan�mpairnrU you were sent momo1hing you did riot order, a|�p|ynu||� Rx Products Controlled Substances: MatPxMedica| 1-800F845~3550 Regulations require onto|imi\|hoox|enfHx and oon|m||od substances unlynmgiste.?ed.|cmnsed healthcare Professionals. U you are anowcustomer m/ have recently d olease furnish us with a copy ur your updated sate mg/stmonn. For controlled nubn1anceo.[:mimhaunovuiyourDEAcnUi6nate.verity|ngynur shipping address, Class i! drugs can bo ordered only Ly --ail. International Orders: Please Note: We proudly serve healthcare pmfeoiono(sand govnmmnnN Openedhandp�uau and equipment may not bar�umodtor throughout thewodd Tnp|aon orders nr «mdiL but will d nd8| nn International Oe �no t mman cm o .pmmannon our pa o� man uhmLuro/war�nUnu B�o�uVonixUhaodpin000nr 1-800-845'86S0 eqxipmooLwa suggest ttatyoocheck the ohi i inor andpeoking list N verily that You havomooived exactly what �mndoed.0pened Computer Software in not returnable. ��i��U Drug Returns ��Q��i��: Other restrictions may also apply. ARo|um Authorization in Required for all Prescription Drugs. Simply call our Customer Service, Dcpartment 1-800-8415-3550. HSI ORDER# ORDER DATE DUE DATE 93926899 08/23/11 09/22/11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 his order aas been processed by our MIDWEST C. 5315 WES 74TH TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23 00304 1 827 -2329 EA SUCTION UNIT W /DISP CANN 1 1 C 717.00 717.00 1 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURCHASE YOU HAVE EARNED A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPOq DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TIME, MEDICARE, MEDICAID, TRIT ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE, PND UPON ANY S CH EQUEST, SU H VALUE MUST BE DISCLOSED AS A DISCOUNT kGAINSr1 THE PURCHASES THAT ARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDI E TOTAL 717.00 Invoice Date 30 days 717.00 LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI4 INC. DEPT CH 10211 ALATINE, I 60055 -0241 BILL TO SHIP TO INVOICE INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1308572 2864133-01 717. 00 B Backordered: Item will follow SK School Kit HSI RDER D Discontinued: Item no longer available NC No Charge D A I E DAT B XE P Special Schein Free Goods 93926899 08/23/11 $/23/11 1 M- Manufacturer will ship Item directly to you P T ER PA E Prescription Drug: Return Authorization Required R Ref rigcratcd Item: May be shipped separately Special Schein Pricing U Temporarily unavailable: please reorder MARK 1 OF 1 T TaxableItem LP300 ayrnew i arras. We make every effort to maintain prices for the duration of a payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however. we reserve the right to make price adjustments in VISA MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: It you have tried a product and it is detective or does not performII Your Order To Your Open Account Available to licensed practitioners in the U.S, All invoices are satisfactorily, tine will provide a credit, refund, or exchange; it's your to choice. Simply call our customer service department within 30 days payable w n days. of receipt of the merchandise to arrange for the return. For a warranty repair or if you were sent something you did not order simply call: Rx Products Controlled Substances: Matrx Medical 1-800-845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. It you are a new customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, furnish a copy of your DEA certificate verifying your shipping address. Class it drugs can be ordered only by mail. International Orders: Pleas Note: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but w be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export manufacturer warranties. before opening handpieces or terms and conditions, please contact our International Department: equipment, we suggest that you check the shipping container 1-800-845-35 0 and packing list to verify that you have received exactly what Prescription Drug Returns Instructions: you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department 1- 800 -845 -3550. HSI ORDER4 ORDER DATE DDE DATE 94172711 09/01/11 10 /01 /11 WHSE DEA# RH0162494 Fed ID: 11- 3136595 0 S' f 3 MINE= This order has been processed by our MIDWEST D.C. 5315 WES 74TH 3TREET INDIANAP LIS,IN 46268 MIDWEST D.C. State Lic 23:00304 RK 317 -42 -8784 1 107 -0502 100 /BX PURPLE NITRILE PF GLOVE MEDIUM 20 20 C 8.25 165.00 2 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 2 107 -0530 100 /BX PURPLE NITRILE PF GLOVE LARGE 60 60 C 8.25 495.00 8 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 3 107 -0540 90 /BX PURPLE NITRILE PF GLOVE X -LARGE 40 40 C 8.25 330.00 12 ASE:GOOD,I EM, MAY BE_SHIPPED SEPARATELY F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E.G. POIN S, GIFTS OR OTHER PECIAL AWA DS "DISCOUNT WITH THIS PURL SE YOU HAVE RNED.A CREDI TOWARD GOODS OR S RVICES, RECEIVABLE OR REDEEMABLE N ACCO DANCE WITH DISCOUNT PROGRAM RULES. UPO4 DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE OTICE OF T E DISCOUNT VALUE. FROM TIME TO TI E, MED CARE, MEDICAID, TRI ARE OR THER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY S CH REQUEST, SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSq THE PURCHASES THAT EARNED SUCH VALUE. ACCORDINGLY, YOU SHOULD RE AIN TH SE RECORDS. MERCHANDISE TOTAL 990.00 nybice Date 30_days 990.00 BILL TO SHTP TO INVOICEff INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 8907551-01 9 9 0. 00 H- Backordered: Item will follow SK School Kit D Discontinued: Item no longer available NC No Charge RD R D E BOXES F Special Schein Free Goods M Manufacturer will ship Item directly to you 94172711 0 9 01 11 9/01/11 12 P Prescription Drug: Return Authorization Required R Refrigerated Item; May be shipped separately CUSTOMER Poll A Special Schein Pricing U Temporarily unavailable; please reorder MARK 1 OF 2 T Taxable Item Continued on Next Page L 92 HENRY SCHEIN@ SHIP TO /SOLD TO: EMS Carmel Fire Department MI 135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St Station 46 Michael Kaufmann Carmel,IN 46032 -8806 010000130857108907551110010000000990000901117 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032 -7543 Carmel Fire Dept MI 2 Civic Sq BILL TO I SHIP TO INVOICE AMOUNT Carmel, IN 46032 -7543 1308571 1817102 990.00 INVOICE INVOICE DATE 8907551 -01 9/01/11 CUSTOMER PO MARK Please detach here and mail the above with your payment HSI ORDER ORDER DATE .DUE DATE 94172711 09/01/11 10 /01 /11 WHSE DEA# RHO] 62494 Fed ID: 11- 3136595 z- LEASE NOTE NEW REMIT TO ADDRESS Please remi payments only to the following a dress: ENRY SCHEI4 INC. EPT CH 102 ALATINE, IL 60055 -0241 la, r T O SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 1817102 8907551-01 9 9 0. 0 0 B- Backordered: Item will follow SK School Kit I ORDER# ORDER DATE INVOICE DATE OF BOXES D Discontinued: Item no longer available NC -No Charge F Special Schein Free Goods M Manufacturer will ship Item directly to you 94172711 0 9 01 11 9/01/11 12 P Prescription Drug: Return Authorization Required R Refrigerated Item: May be shipped separately CUSTOM Special Schein Pricing MARx 2 F 2 U Temporarily unavailable: please reorder T Taxable Item L M HENRY SCHEIN O" EM TERMS OF SALE Payment Terms: We make every effort to maintain prices for the duration of a Payment by CHECK or by the HENRY SCHEIN CREDIT CARD, catalog, however, we reserve the right to make price adjustments in VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS response to manufacturers' price changes Guaranteed Satisfaction: If you have tried a product and it is defective or does not perform or satisfactorily, we will provide a credit, refund, or exchange; it's your Bill Your Order To Your Open Account choice. Simply call our customer service department within 30 days Available to licensed practitioners in the U.S. All invoices are of receipt of the merchandise to arrange for the return. For a payable within 30 days. warranty repair or if you were sent something you did not order, simply call: Rx Products Controlled Substances: Matrx Medical 1- 800 -845 -3550 Regulations require us to limit the sale of Rx and controlled substances only to registered, licensed healthcare professionals. If you are a new customer or have recently moved, please furnish us with a copy of your updated state registration. For controlled substances, furnish a copy of your DEA certificate verifying your shipping address. Class II drugs can be ordered only by mail. International Orders: Pleas N ote: Opened handpieces and equipment may not be returned for We proudly serve healthcare professionals and governments credit, but will be repaired or replaced in accordance with throughout the world. To place orders or for inquiries on export manufacturer warranties, Before opening handpieces or terms and conditions, please contact our International Department: 1-800-845-3550 equipment, we suggest that you check the shipping container and packing list to verify that you have received exactly what Prescription Drug Returns Instructions you ordered.Opened Computer Software is not returnable. Other restrictions may also apply. A Return Authorization is Required for all Prescription Drugs. Simply call our Customer Service Department 1- 800 -845 -3550. �u a. 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)) 2864133 -01 $717.00 8907551 -01 $990.00 I 2081646 -01 I I $43.84 2872739 -01 $495.76 1008973 -01 $11.69 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. WARR NO. ALLOWED 20 Henry Schein IN SUM OF Dept Ch 10241 Palatine, IL 60055 $2,258.29 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 1120 2864133 -01 102 670.06 $717.00 1 hereby certify that the attached invoice(s), or 1120 8907551 -01 102 390.11 $990.00 bill(s) is (are) true and correct and that the 1120 I 2081646 -01 1 102 390.11 I $43.84 materials or services itemized thereon for 1120 2872739 -01 102 390.11 $495.76 which charge is made were ordered and 1120 1008973 -01 102 390.11 $11.69 received except CEP 12 2011 Ji ll b Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund