178260 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
ONE CIVIC SQUARE LIFESAVERS, INC
CARMEL, INDIANA 46032 39 PLYMOUTH STREET CHECK AMOUNT: $99.93
FAIRFIELD NJ 07004
CHECK NUMBER: 178260
CHECK DATE: 10/1412009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1046 4239012 26008 99.93 SAFETY SUPPLIES
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INC,, Invoice
F 't
C::39-P_Lymouth- Strect Date Invoice
Fairf eld
�\I` SEP 2 1 7009 9LI2009 26(` 008
Phone: (973)244-9111 Fax: (973)244-1666
c Bill To Ship To
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Carmel Clay Parks Recreation Monon Center
Administrative Offices 1235 Central Park Dr. E.
1411 E. 116th Street Carmel, IN 46032
Carmel IN 46032 Attn: Linda Acosta
P.O. Number Terms Rep Entered On Ship Via F.O.B. Project
2258$ Net 30 MG 9/18/2009 UPS origin
Quantity Item Code Description Price Each Amount
7 73 -404 CPR Micromask Black Pouch 10.75 75.25
20 MI.SCFA Disposable Thermometer 0.25 5.00
3 211-030 9628 Non -Stick Pads 2" x 3" 4 /unit 1.14 3.42
3 2 1 1 -01 1 Gauze Pads 3 "x3" 4 /unit- #637 0.80 2.40
3 213-011 4663 Certi Sporyn Antibiotic Cream I gm. 10 /unit 1.80 5.40
1 S H Shipping Handling 8.46 8.46
1 ZY527Y 10340496164
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Description fah Cr,l_G�
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G L 0 L l OD 00 S q113 90
Bu d Un e get
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Purchaser Date
Approv Date
A11 Discrepancies must be reported within 5 days after receipt of products (973)244 -91 1 1
Total c�9 9
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
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Fairfield, NJ 07004
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9118109 26008 First aid supplies 22588 F 99.93
Total 99.93
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 L.ifeSavers, Inc. Allowed 20
39 Plymouth Street
Fairfield, NJ 07004
In Sum of
99.93
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1046 26008 4239012 99.93 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
7 -Oct 2009
Signature
99.93 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund