172996 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 355226 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY CENTER, INC CHECK AMOUNT: $354.41
r o CARMEL, INDIANA 46032 PO Box 2370
EUGENE OR 97402 CHECK NUMBER: 172996
CHECK DATE: 5/2712009
DEPARTM ACC OUNT PO NUM INVOICE NU MBER AMOUNT DESCRIPTION
102 4239011 178928IN 354.41 SPECIAL DEPT SUPPLIES
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PuMic Safety Cent
AfTi 01'Jy 4110 tfaligfef8r I nvoice-
R0, Rox 23 Agv'�Zb� Flay (Ufeleay ffolil y0a bank to our'�;
A
Eugene, OR 9 740 G V. 1 Use our routing 1'23205 Order Date I Invoice 4
and our accowit. 20025714
Fax 54
Bill To 3i tip To
Carmel F u la Dept I I LaFM el Fl Dept
Attn: Accounts Payable Attn: Mark Hulett
2 Civic Sq 1540 W 136 St
Carmel 116l 460:12 Carmel IN 46022
I i
j r
il
P.O. Nurnber 1 e rt I I'S R e p* I %J. a till e 11-1VOIC ie! 3hip Daie Si lip Lea P Mfle;&
MARK Net 30 I Danil- I 5/14/2009 Ground 1 317/571-2600 1
Qwpnfity ftQm. Cole Description Price P-ach Amount
2 r- i 1 7 r- n r) o ir as ;,1 00
1 441204
44 7- 1. Z Gauze Sterile Pz:d5 4x4 12 p 1 y 121 IV) 101 6.0
1 j. I3 j (2 packs)
2 1441504 (PIRM Y" Sterile conforming Gauze 2 X 4yd 37.87 j 75.7 A
100 NONTRI200 l Bandages, Triangular bandages, 36x36x51in 0.59 l 59.00
14 1 NOTE: Remai,nder of item(s) t--D f
I 1S I Shipping (NOTE: Includes shipping for any 67.69 1 67.69
I j items to follow)
':--dEx Ground 'Tracking Numbe—r(s): nn
kj/ U, I-IQ -Ji V, 6715800502t54
073671580u50271,01
073671580050295
i i f
Tota 0 $364AI
W-9 INFURMN110N: PUBLIC SAFET'YCENTEX IS AN URECION CORP FIN 7493-1319770
NY 1TEMS RET LWNED 60 DAYS OR MoRE AFTER RECEIPT ARE S Tc:) k RESTOCK FEE.
VOUCHER NO. WARRANT N
Public Safety Center ALLOWED 20
IN SUM OF
P.O. Box 2370
Eugene, OR 97402
$354.4
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO Dept. iNVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 178928IN 102 390.11 $354.41 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
MAY 2 2 2009
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))
178928IN $354.41
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