170071 03/18/2009 CITY OF CARMEL, INDIANA VENDOR: 355226 Page 1 of 1
ONE CIVIC SQUARE PUBLIC SAFETY CENTER, INC
I CHECK AMOUNT: $937.49
CARMEL, INDIANA 46032 PO BOX 2370
o; EUGENE OR 97402 CHECK NUMBER: 170071
CHECK DATE: 3/18/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 174340IN 937.49 SPECIAL DEPT SUPPLIES
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I
Public Safety Center, hic. "Electronic Transfer" a M P
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ACH only (no wire transfers!) 1 s
P.O. Box 2370 Pay directly from your bank to ours
Eugene, OR 97402 T Use our routing 123205135 Order Date Invoice
and our account 20025714
3;3/2009 174340IN
541.344.8434 Fax S41. 686 -1373
Bill To Ship To
Carmel Fire Dept Carmel Fire Dept
Attn: Accounts Payable Attn: EMS Dir Mark Hulett
2 Civic Sq S40 W 136 St
Carmel IN 46032 Carmel IN 46032
P.O. Number Terms Rep Name Invoice /Ship Date Ship Via Phone
MARK Net 30 Danil- 3/5/2009 Ground 317/571 -2600
Quantity. Item Code Description Price Each Amount
40 770OPFTM Gloves, Nighthawk Disposable- Size Medium 6.40 256.00
40 7700PFTL Gloves, Nighthawk Disposable- Size Large 6.40 256.00
40 770OPFTXL Gloves, Nighthawk Disposable- Size 'X-Large 6.40 256.00
2 770OPFTS Gloves, Nighthawk Disposable- Size Small 6.40 12.80
1. Shipping 156.69 156.69
1 1 FedEx Ground Tracking Number(s): 0.00
073671530026721 ,073671530026738,
073671530026745 ,073671530026752,
073671530026769 ,073671530026776,
073671530026783
Total $937.49
W -9 INFORMATION: PUBLIC SAFETY CENTER IS AN OREGON CORP FIN #93- 1319770
ANY ITEMS RETURNED 60 DAYS OR MORE AFTER RECEIPT ARE SUBJECT TO A 10% RESTOCK FEE.
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VOUCHER NO. WARRANT NO.
ALLOWED 20
Public Safety Center
IN SUM OF
P.O. E6ox 2370
Eugene, OR 97402
$937.49
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 174340IN 102 390.11 $937.49 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
MAR 16 2009
r 'o"
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))
174340IN EMS Supplies $937.49
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