213551 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 362944 Page 1 of 1
0 ` ONE CIVIC SQUARE LIFESAVERS,INC CHECK AMOUNT: $63.20
CARMEL, INDIANA 46032 39 PLYMOUTH STREET
FAIRFIELD NJ 07004 CHECK NUMBER: 213551
CHECK DATE: 10/912012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4239039 48506 63 .20 GENERAL PROGRAM SUPPL
LIFESAURS, INC . �dT�'� Invoice
—u�—v+�,—vt OCT 0 12012
39 Plymouth Street Date Invoice#
Fairfield NJ 07004
9/26/2012 48506
Phone:(973)244-9111 Fax:(973)244-1666
Bill To Ship To
Carmel Clay Parks Recreation West Clay Elementary School
Administrative Offices 3495 West 126th Street
1411 E. l 16th Street Carmel IN 46032
Carmel, IN 46032 Attn: Jen Hammons
P.O. Number Terms Due Date Rep Ship Via F.O.B.
—Haag Net 30 10/26/2012 MG Fed Ex origin
�(X.X)22�y0
Quantity Item Code Description Price Each Amount
4 216-003 4652 Adhesive Tape- 1/2" x 2 1/2 yd. 2/unit 1.10 4.40
2 215-010 #658,Certi-Burn Gel, 1/8 oz.,6/unit 2.75 5.50
4 213-011 4663 Certi-Sporyn Antibiotic Cream - Igin. 10/unit 1.80 720
4 213-038 #675 Antiseptic Cleansing Towelettes- 10/unit 0.96 3.84
5 210-018 #677 Adhesive Bandages-Junior-40/unit 1.74 8.70
2 213-019 #711 Insect Sting Swabs 10/unit 3.40 6.80
2 216-025 #794 Hydrocortisone Cream 1 gm. 6/unit 1.78 3.56
4 211-029 #647 Gauze Pads-2" x 2" 6/unit 0.98 3.92
2 211-033 #636 Triangular Bandage w/pins- 1/unit 1.56 3.12
2 211-024 Gauze Bandage-2"x 6 yd. -2/unit-#634 230 4.60
1 210-008 Adhesive Bandages- Skin Closures- 16/unit-#605 1.56 1.56
1 S&H Shipping& Handling 10.00 10.00
#9612019010756760221038
Purchase
Description nJ
P.O.# t-0 O 02$L}O P F
G.L.# t 031-1 O- 4 23903
Budget lcr(5l Pr rate t- ILs
Line esc-�-
Purchaser (T (3
Date
Approval-f)VIC2 C+� F)er t7 I 11i�2
All Discrepancies must be reported within 5 days after receipt of products(973)244-9111
Total $63.20
L
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
9/26/12 48506 Supplies $ 63.20
Total $ 63.20
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$
$ 63.20
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITL AMOUNT Board Members
Dept ept#
1081-10 48506 4239039 $ 63.20 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
4-Oct 2012
7�
Signature
$ 63.20 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
s