174994 07/22/2009 CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
ONE CIVIC SQUARE LIFESAVERS, INC
CARMEL, INDIANA 46032 39 PLYMOUTH STREET CHECK AMOUNT: $654.63
FAIRFIELD NJ 07004 CHECK NUMBER: 174994
CHECK DATE: 7/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1047 4239012 24249 654.63 SAFETY SUPPLIES
,a
Invoice
39 Plymouth Street 7JUN 2 2 2009 Date Invoice
Fairfield NJ 07004 6/12/2009 24249
Phone:(973)244 -9111 Fax:(973)244- 1666 =1
Bill To Ship To
3 Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
1411 E. 116th Street Carmel, IN 46032
Carmel IN 46032 Attn: Denisse Jensen
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
22027 Net 30 RS 6/12/2009 UPS origin
Quantity Item Code Description Price Each Amount
75 73 -404 CPR Micromask Black Pouch 8.55 641.25
1 FRCHG Freight 13.38 13.38
1ZY527Y10340631150
Purchase
Descries CPS
P.O. �L Part) no _F
G.La n��l�~ a39o
Bud
Una
AppmvA
�r�chaser
All Discrepancies must be reported within 5 days after receipt of products (973)244 -91 1 I
Total $654.63
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
6112/09 24249 CPR masks 22027 F 654.63
Total 654.63
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
654.63
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TlTLE AMOUNT Board Members
Dept
1047 24249 4239012 654.63 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
16 -Jul 2009
Signature
654.63 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund