177296 09/15/2009 a. CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
ONE CIVIC SQUARE LIFESAVERS, INC
CARMEL, INDIANA 46032 39 PLYMOUTH STREET CHECK AMOUNT:. $882.22
FAIRFIELDNJ 07004
CHECK NUMBER: 177296
CHECK DATE: 9/15/2009
DEPARTME A CCOUN T PO NUMBER INVOICE NUMBER AM OUNT DESCRIPTION
1046 4239039 25414 882.22 GENERAL PROGRAM SUPPL
Lff Invoi &L 3 a 3 9 V 3 D�
39 Plymouth Street Date Invoice #r'
Fairfield NJ 07004 AUG 2 4 7009
8/18/2009 25414
Phone: (973)244-9111 FiLx: (973 )244 -1666 '�}q(��}�y
2'6O' AO p. LCS•S4S SJISSLSJSJl 55
Bill To Ship To
Carmel Clay Parks Recreation Monon Center
i. Administrative Offices 1235 Central Park Dr. E.
1411 E. 116th Street Carmel, IN 46032
Carmel 1N 46032
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
22380 Net 30 RS 8/18/2009 UPS origin
Quantity Item Code Description Price Each Amount
11 220 -202 Adhesive Woven Bandages 'J'/4 "`x'3" 100/box 5.30 5830
11 220 -103 Adhesive Vinyl Bandages 1 "x 3 I00/box 4.10 45.10
0 221 -035 Peroxide, Hydrogen 3oz, Non- Aerosol"Spray 3.60 0.00
0 221 -031 Antiseptic Spray -BZK -3oz 4.60 0.00
11 233 -361 Certicporyn Triple Antibiotic Ointment -1 gm 50/box 7.70 84.70
22 221 -039 Antiseptic Wipes 50/box 3.80 83.60
11 231 -203 Gauze Pads Sterile 2 "x 2" 100/box 8.60 94.60
22 231-211 Gauze Pads 3" x 3" 251box 3.10 68.20
22 240 -037 Adhesive Certi -Tape Tri -Cut 2" x 5yd spool 2.95 64.90
33 242 -013 Tweezers First Aid Kit 0.88 29.04
11 221 -038 Antimicrobial Wipes 50/box 7.40 81.40
33 216 -025 #794 Hydrocortisone Cream 1 gm. 6 /unit 1.78 58.74
22 233 -007 Certi -Burn Spray 3 oz 4.10 90.20
11 PS2088 Glove Nitriles Blue Large 100/bx 8.50 93.50
1 S H Shipping Handling 29.94 29.94
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LDiscrepancies must be reported within 5 days after receipt of products (973)244-9111
Total :$:8 a2.22
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
8118/09 25414 First Aid supplies 22380 p 882.22
Total 882.22
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. Warrant No.
362944 LifeSavers, Inc. Allowed 20
39 Plymouth Street
Fairfield, NJ 07004
In Sum of
,R
882.22
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 25414 4239039 882.22 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
10 -Sep 2009
r
Signature
882.22 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund