205262 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 355226 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY CENTER, INC CHECK AMOUNT: $759.90
CARMEL, INDIANA 46032 8248 W DOE AVENUE
VISALIA CA 93291 CHECK NUMBER: 205262
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4467006 5296929 759.90 EMS EQUIP
INVOICE
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INVOICE
Pubfi Sa fi J C er 5296929
5248 West Doe Ave.
Visalia, CA 93291 Invoice Date Page
Phone: 1.866.646.4434 12/28/2011 26 of 28
mm- puhlicsafetycenter.com ORDER NUMBER
1181442
Bill To: Ship To:
Carmel FD Cannel FD
ATTN: ACCOUNTS PAYABLE ATTN: MARK HULETT
2 CIVIC SQ. 2 Civic Sq.
Carmel, IN 46032 Cannel, IN 46032
US US
Customer 11): 152610
PO Number Terms Description A'et Due Date Disc Due Date Discount Amount
Net 30 1/27/2012 1/27/2012 0.00
Order Dade Pick Ticket Ao Joh A'o Freight Primary Salesrep Name Taker
12/16/2011 3185569 00 4000000KRpQ3AAL Prepaid Harriett Keys Automated Service
/tern ID Item Description UO,t/ Unit Extended
Or ered Shipped Unit Sipe Price Price
Delivery Instructions: Free Freight
Carrier: UPS- Ground Tracking I ZXX08030347064138
I I GRP51926 Nonwoven. MegaMover 1500 C90.0000 229.9000 229.90
"Portable Transport Unit, 4!) x 80 White (10 /CS)"
50 50 MESBC -H001 Disposable Head Immobilizer w/ Straps PR 1.0000 5.6000 280.00
3 3 SEM8845 -00 -ORG Fanny Pack Orange LA 1.0000 0.0000 0.00
50 50 ML'SBC -2601 1 OR Flex -all Splint, Orange EA 1.0000 5.0000 250.00
SOLD AS EACHES (100 /CS)
Total Lines 4 SUB- TOTAL: 759.90
TAX: 0.00
AMOUNT DUE: 759.90
ORIGINAL
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))
5296929 $759.90
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
VOUCHER NO. WAR N
ALLOWED 20
Public Safety Center
IN SUM OF
8248 W. Doe Avenue
Visalia, CA 93291
r l $759.90
i�
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 I 5296929 102 670.06 I $759.90 1 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
JAN 4 2012
f N,.
a
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund