173425 06/10/2009 CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
ONE CIVIC SQUARE LIFESAVERS, INC CHECK AMOUNT: $4,416.57
CARMEL, INDIANA 46032 39 PLYMOUTH STREET
ti FAIRFIELD NJ 07004 CHECK NUMBER: 173425
CHECK DATE: 6/10/2009
DEPARTMEN ACCOUNT P NUMBER INVOICE NUMBE AMOUN DES CRIPTION
1047 4239012 23724 1,319.91 SAFETY SUPPLIES
1047 4239012 23726 1,852.00 SAFETY SUPPLIES
1047 4239012 23732 133.90 SAFETY SUPPLIES
1047 4239012 23735 677.11 SAFETY SUPPLIES
1047 4239012 23765 433.65 SAFETY SUPPLIES
LIF Invoice
39 Plymouth Street Date Invoice
Fairfield N.1 07004 2009 5/15/2009 23765
Phone: (973)244-9111 Fax: (973)244-1666
Y:..
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.B. Project
20937 Net 30 RS 5/15/2009 UPS origin
Quantity Item Code Description Price Each Amount
4 M5071A Philips Onsite Adult Smart Pads Cartridge 59.00 236.00
2 M5072A Philips Onsite Pediatric Smart Pad Cartridge 95.00 190.00
1 FRCHG Freight 7.65 7.65
1ZY527Y 10341 177006
PUMhM
P.o. aoa 37 P
G.IL A U "7 .100 1QQ- r-I•- a 390 1
Budget F•I RSr A I
Llne Desar
Purchaser Data
Approval Date
All Discrepancies must be reported within 5 days after receipt of products (973)244 -91 1 I
Total $433.65
LIFES dI�V�" In voice
39 Plymouth Street Date Invoice
Fairfield NJ 07004 5/14/2009 23724
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
MAY 262 09
BY
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
20797 Net 30 RS 5/14/2009 UPS origin
Quantity Item Code Description Price Each Amount
20 PS2087 Gloves Nitrile Blue Medium 100 /bx 8.50 170.00
20 PS2089 Gloves Nitrile Blue Xtra large 90 /BX 8.50 170.00
1 209 -039 FAC -3 Empty Metal 3 Shelf Cabinet 39.95 39.95
1 206 -019 4XXV -16M Standard Kit w /Eye Wash No CPR Metal 31.95 31.95
8 220 -151 Fingertip woven Med 100 /bx 13.95 1 1 1.60
0 220 -251 Knuckle Woven I00bx 10.00 0.00
12 220 -205 Adhesive Woven Bandages -1 "x 3" -100 /box 5.80 69.60
12 230 -220 Stretch Gauze Sterile 2" X 4.1 yd 1.10 13.20
12 D3353 Gauze Sterile 3 X 3 12 Ply -100 bx 4.65 55.80
36 228 -347 Elastic Cohesive Bandage, Certi -Rip 3 "x 5yd. 3.75 135.00
36 504 -020 Adhesive Transparent Clear Tape 1" X 10 Yd 1.40 50.40
7 234 -005 Ice Pack- Certi Cool Large Bulk 25 an 18.75 131.25
12 233 -358 Certi -Sporyn Antibiotic Cream 25/bx 4.00 48.00
24 1.2- 252102 Ambu Rescue Mask with 02 inlet valve and headstrap 12.75 306.00
5 270 -060 1LSC -15 Powder 15 oz. Bag 8.90 44.50
Subtotal 1,377.25
DISC Special Discount if order is placed in full 12.50% 172.16
FRCEIG Freight 114.82 114.82
1ZY527Y10340370281
1 ZY527Y 10340 l 54890
IZY527Y10340624702 PurehM l ZY527Y 10340243712 F1 PST- D u
1 ZY527Y 10340955926 112. 0. 0 L. p_7 p n0
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Une ewaw X17
Purchaser Date
Appm Date All Discrepancies must be reported within 5 days after receipt of products (97))244-9111
TOtal $1,319.91
1LI1�ES �'�11�S INC w'� Invoice
39 Plymouth Street MA 2 6 009 r9 Date Invoice
Fairfield NJ 07004 5/14/2009 23726
Y
Phone: (973)244 -9111 Fax: (973)244 -1666 U
Bill To Ship To
Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
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
20765 Net 30 RS 5/14/2009 UPS origin
Quantity Item Code Description Price Each Amount
5 216 -015 4783 Forceps Scissors I each /unit 1.54 7.70
50 220 -260 Cert Strip 1 "x 3" woven 50 bx 3.40 170.00
25 211-002 Bandage Compress- 2" 4 /1 9622 3.20 80.00
25 211-005 #623 Bandage Compress 3" 2 /unit 2.50 62.50
25 211-008 9624 Bandage Compress 4" 1 /unit 1.96 49.00
10 231-211 Gauze Pads 3" x 3" 25 /box 3.10 31.00
25 211-014 Gauze Compress 18" x 36" 2/ unit- 4638 3.00 75.00
25 211 -021 #640 Gauze Compress 24 "x 72" 1 /unit 2.40 60.00
25 211-027 Gauze Bandage 4" x 6yd. 1 /unit- 4635 1.62 40.50
15 211 -033 4636 Triangular Bandage w /pins 1 /unit 1.56 23.40
6 234 -005 Ice Pack- Certi Cool Large Bulk 25 ctn 18.75 112.50
15 216 -081 Gloves Nitrile 2 /bag 0.58 8.70
10 216 -003 4652 Adhesive Tape 1 /2" x 2 1/2 yd. 2 /unit 1.10 11.00
4 M5071A Philips Onsite Adult Smart Pads Cartridge 59.00 236.00
2 M5072A Philips Onsite Pediatric Smart Pad Cartridge 95.00 190.00
100 73 -404 CPR Micromask Black Pouch 8.62 862.00
Subtotal 2,019.30
DISC Special Discount if order is placed in full 12.50% 252.41
1 FRCHG Freight 85.11 85.11
IZY527YI0342785339
1 ZY527Y 10341435941 Purchm
IZY527YI0340891754 DsscrlptWF 5U p
1 ZY527Y I0342016768 p.0. L a U p t-1D
0.11-811 4 j-1D0- tb0 a
Budget 5AP�
LJrse
Purchaser Days
Approv Daft
All Discrepancies must be reported within 5 days after receipt of products (973)244 -91 1 I
Total $1,852.00
Invoice
-Y. i
39 Plymouth Street MAy 2 6 2009 Date Invoice
Fairfield NJ 07004 5/14/2009 23732
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.B. Project
20795 Net 30 RS 5/14/2009 UPS origin
Quantity Item Code Description Price Each Amount
6 233 -319 First Aid Cream 1 gm 25 /bx 4.20 25.20
6 233 -358 Certi -Sporyn Antibiotic Cream 25 /bx 4.00 24.00
6 225 -152 Hydrocortisone Cream 25 /bx 4.50 27.00
6 235 -089 Insect Sting Swabs 25 /bx (Substitute 213 -021 Insect 4.00 24.00
Sting Wipes)
6 221 -027 Antiseptic BZK Towelettes I00 /bx 7.10 42.60
142.80
DISC special discount if order is placed in full 12.50% -17.85
1 FRCHG Freight 8.95 8.95
1 ZY527Y 10340730383
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APPO
Thank you for your business. Inquiries (973) 244-9111
Total $133.90
t -s fir..- P
LIFFSAMR-5, INC.
Invoice
39 Plymouth Street MAY 2 6 200 Date Invoice
Fairfield NJ 07004 7-
0 5/14/2009 23735
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.
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
20796 Net 30 RS 5/14/2009 UPS origin
Quantity Item Code Description Price Each Amount
4 220 -202 Adhesive Woven Bandages 3/4" x 3" 100 /box 5.30 21.20
4 220 -220 Knuckle Woven Bandage 50 /box 5.80 23.20
4 504 -095 Woven Fingertip Large 50 /box 9.30 37.20
4 220 -209 Woven Fingertip Small -25 /bx 3.30 13.20
4 220 -014 Adhesive Vinyl Bandages Jr. XL -100 /box 3.30 13.20
The Above items were to substitute for your 280 CT
MultislZe Band- Aids
4 220 -205 Adhesive Woven Bandages -1 "x 3" -100 /box 5.80 23.20
2 PS2088 Glove Nitriles Blue Large 100 /bx 8.50 17.00
24 12- 252102 Ambu Rescue Mask with 02 inlet valve and headstrap 12.75 306.00
6 213 -019 #71 1 Insect Sting Swabs 10 /unit 3.40 20.40
3 230 -220 Stretch Gauze Sterile 2" X 4.1 yd 1.10 3.30
3 230 -221 Stretch Gauze Strerile 4" x 4.1 yd 1.50 4.50
1 231-211 Gauze Pads 3" x 3" 25 /box 3.10 3.10
1 231 -213 Gauze Pads 4 "x 4" 25 /box 4.40 4.40
6 228 -104 Ace Style Elastic Bandage 3" x 5" yd. 1.30 7.80
2 229 -060 Certi -Ose Eye Wash 4oz 2.50 5.00
2 221 -007 Alcohol Wipes 100 /box 3.20 6.40
2 233 -358 Certi -Sporyn Antibiotic Cream 25 /bx 4.00 8.00
6 216 -033 Certi Cool Jr. #699x Unitized I /box 1.00 6.00
4 240 -009 Adhesive Tape I' x 5yd. Spool 3.10 12.40
1 206 -210 FAC -3 -DLX Deluxe 3 Shelf Metal Cabinet W supplies 12995 129.95
Subtotal 665.45
DISC Discount if order is p laLa l 1ii1�5'r A "Ib S�PP�� -12.50 -12.50
1 FRCI -IG Freight DewAptiol 24.16 24.16
P.O. D`7 K I PcQ 110
IZY527Y1034184699SG.L# L l I�� /0D `j:�9
I ZY527Y 1034088880t. Destx vCL�
Purchases Date
ADoroval
All Discrepancies must be reported within 5 days after receipt of products (973)244-9111
Total $677.11
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.
Terms
LifeSavers, Inc.
39 Plymouth Street
Fairfield, NJ 07004
Invoice Invoice Description PO Amount
Date Number (or note attached invoice(s) or bill(s))
20937 433.65
5/15/09 23765 AED Supplies 20797 1,319.91
5/14/09 23724 First aid supplies 20765 1,852.00
5/14/09 23726 First aid supplies 20795 133.90
5/14/09 23732 First aid supplies 20796 677.11
5/14/09 23735 First aid supplies
U! Total 4,416.57
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.
LifeSavers, Inc. Allowed 20
39 Plymouth Street
Fairfield, NJ 07004
In Sum of
4,416.57
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1047 23765 4239012 433.65 1 hereby certify that the attached invoice(s), or
1047 23724 4239012 1,319.91 bill(s) is (are) true and correct and that the
1047 23726 4239012 1,852.00 materials or services itemized thereon for
1047 23732 4239012 133.90 which charge is made were ordered and
1047 23735 4239012 677.11 received except
4 -Jun 2009
Signature
4,416.57 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund