177747 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
e ONE CIVIC SQUARE LIFESAVERS, INC
CARMEL, INDIANA 46032 39 PLYMOUTH STREET CHECK AMOUNT: $764.57
FAIRFIELD NJ 07004 CHECK NUMBER: 177747
CHECK DATE: 9/29/2009
DEPART A CCOUNT PO N UMBER I NVOICE NUMB AMOUNT D ESCRIP TION
1047 4239012 25603 124.68 SAFETY SUPPLIES
1046 4239039 25708 270.60 GENERAL PROGRAM SUPPL
1047 4239012 25747 369.29 SAFETY SUPPLIES
Invoice
C r Date Invoice
39�jlymouth.Street
Fairfield_Nj
200 [-_8/28/2009
Phone: (973)244-9111 Fax: (973)244-1666 SEQ D zs o3
Bill To Ship To
Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
4 141 1 E. 1 16th Street Carmel, IN 46032
Carmel IN 46032
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
C- 22.4.8 7 y Net 30 RS 8/28/2009 UPS origin
Quantity Item Code Description Price Each Amount
2 M5071A Philips Onsite Adult Smart Pads Cartridge 59.00 118.00
1 S H Shipping Handling 6.68 6.68
I ZY527Y 1 0341336558
Purchase
Description Pit D LAS
P.o.# aa4 P
G.L t#
Bud
Une spa
une esa
Purchaser Date
Approv Date
Total c- 124 -.6s
LIFESAVER ,YN Invoice
39 Plymouth Street Date Invoice
?Fairfield NJ 07004 9/2/2099 25708
Phone: (973)244-9111 Fax: (973)244-1666
Bill To Ship To
Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
1411 E. 116th Street Carmel, IN 46032
Carmel IN 46032
P.O. Number Terms Rep Entered On Ship Via F O.f3. Project
__22380 Net 30 RS 9/2/2009 UPS origin
Quantity Item Code Description Price Each Amount
0 220 -202 Adhesive Woven Bandages 3/4" x 3" 100 /box 5.30 0.00
0 220 -103 Adhesive Vinyl Bandages I "x 3 100 /box 4.10 0.00
33 221 -035 Peroxide, Hydrogen 3oz, Non Aerosol Spray 3.60 118.80
33 221 -031 Antiseptic Spray -BZK -3oz 4.60 151.80
0 233 -361 Certicporyn Triple Antibiotic Ointment Igm -50 /box 7.70 0.00
0 221 -039 Antiseptic Wipes 50 /box 3.80 0.00
0 231 -203 Gauze Pads Sterile 2 "x 2" 100 /box 8.60 0.00
0 231-211 Gauze Pads 3" x 3" 25 /box 3.10 0.00
0 240 -037 Adhesive Certi -Tape Tri -Cut 2" x 5yd spool 2.95 0.00
0 242 -013 Tweezers First Aid Kit 0.88 0.00
0 221 -038 Antimicrobial Wipes 50 /box 7.40 0.00
0 216- 025 4794 Hydrocortisone Cream I gm. 6 /unit 1.78 0.00
0 233 -007 Certi -Burn Spray 3 oz 4.10 0.00
0 PS2089 Glove Nitriles Blue Large 100/bx 8.50 0.00
0 S H Shipping Handling 0.00
Purchase
Description I 1 t
P.O. a"1a3�'O P f nd 7�E '�P G.L. I Q 900 Bud S 8 2003
Line Descr i
Purchaser Date i._
Approval Date All Discrepancies must be reported within 5 days after receipt of products (973)244-9111
Total $270.60
L ,YFE55A IN C. Invoice
39 Plymouth Street Date Invoice
Fairfield NJ 07004 9/3/20Q9 4 2574_7_
Phone:(973)244 -9111 Fax: (973)244-1666
Bill To Ship To
Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
1411 E. 1 16th Street Carmel, IN 46032
Carmel IN 46032
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
22524+n Net 30 RS 9/3/2009 UPS origin
Quantity Item Code Description Price Each Amount
10 PS2087 Gloves Nitrile Blue Medium 100 /bx 8.50 85.00
20 PS2088 Glove Nitriles Blue Large 100 /bx 8.50 170.00
10 PS2089 Gloves Nitrile Blue Xtra large 90 /BX 8.50 85.00
1 S H Shipping Handling 29.29 29.29
1ZY527Y10341344183
S E P 0 s 2009
Purchase
Description (ove5 Mc,
P.O. P or h�
G.L. 4`1, Qp Vo. 4
Line D et C�
Line escr
Purchaser Date
Approval Date
All Discrepancies must be reported within 5 days after receipt of products (973)244-9111
Total $3-69,2P
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
362944 LifeSavers, Inc. Terms
39 Plymouth Street
Fairfield, NJ 07004
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
8128109 25603 AED Pads 22487 F 124.68
9/2109 25708 First Aid supplies 22380 F 270.60
913109 25747 Gloves MC 22524 F 369.29
Total 764.57
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. Warrant No.
362944 LifeSavers, Inc. Allowed 20
39 Plymouth Street
Fairfield, NJ 07004
In Sum of
764.57
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 25603 4239012 124.68 1 hereby certify that the attached invoice(s), or
1046. 25708 4239039 270.60 bill(s) is (are) true and correct and that the
1047 25747 4239012 369.29 materials or services itemized thereon for
which charge is made were ordered and
received except
24 -Sep 2009
Signature
764.57 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund