HomeMy WebLinkAbout216207 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 362351 Page 1 of 1
ONE CIVIC SQUARE SUNSHINE MEDICAL
CHECK AMOUNT: $353.95
CARMEL, INDIANA 46032 31575 GLENDALE
LIVONIA MI 48150 CHECK NUMBER: 216207
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239012 109996 3 . 95 SAFETY SUPPLIES
1110 R4239012 25563 109996 350 . 00 LATEX GLOVES
Sunshine Medical Supply, Inc. Invoice
31575 Glendale St.
Date Invoice#
Livonia, MI 48150
734-293-7500 fax 734-293-7505 12/20/2012 109996
www.sunshinemedicalsupply.net
Bill To Ship To
Cannel Police Dept Carmel Police Dept
3 Civic Square 3 Civic Square
Cannel,Indiana 46032 Carmel,IN 46032
ATTN:Robert Robinson
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 15 KMG 12/20/2012
Quantity Item Code Description Price Each Amount
10 SUPRENO-EC-M-... SUPRENO EC NITRR,E POWDER FREE EXAM GLOVES 8.75 87.50T
BY MICROFLEX
50BX--10 BX/CS SIZE M
EXTENDED CUFF,POLYMER COATING
20 SUPRENO-EC-L-... SUPRENO EC NITRILE POWDER FREE 8.75 175.00T
EXAM GLOVE BY MICROFLEX
50BX--10 BX/CS SIZE L
EXTENDED CUFF,POLYMER COATED
10 SUPRENO-EC-XL... SUPRENO EC NITRILE POWDER FREE 8.75 87.50T
GLOVES BY MICROFLEX
50BX--10 BX/CS SIZE XL
EXTENDED CUFF,POLYMER COATED
MISCELLANEOU... FUEL SURCHARGE 3.95 3.95T
Out-of-state sale,exempt from sales tax 0.00% 0.00
Thant:you for your business.
Total $353.95
INDIANA RETAIL TAX EXEMPT PAGE
City o :•i bR °,�anal CERTIFICATE NO.003120155 002 0 ul CS.�s. li PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 25M
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Sunchims Modical Supply, Inc. Carmel Police Department
VENDOR SHIP 3 CIVIC Square
TO
39575 Glendale Stmet Camel, IN 40032
Livonia, M91 40950 (317)571-2%9
CONFIRMATION BLANKET 'CONTRACT PAYMENTTERMS FREIGHT
QUANTITY gUNIT�yOF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 92-M.4L
40 Each latex gloves $8.75 $350.00
Sufi Total: $350.00
a t1
i
1
Send Invoice To: �
Carmel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmol, IN 41 2- PLEASE INVOICE IN DUPLICATE
DEPARTMENT , ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. ,S PAYMENT $W.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE/IS AN�NOBLIGATED BALANCE IN
THIS APPROPR���FFIC� I��" ENT TO PAY FOR THE ABOVE ORDER.
•
SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. IP d$Police•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
Iv
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
c" A . COPY-SIGN AND RETURN TO CLERK'S OFFICE
DOCUMENT CONTROL NO. ,
VOUCHER NO. ._..__WARRANT
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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
20
---- - .-... ...-_....... ... ................ --.....................---- ------ _ -—
Signature
--------------- ----- - .—._--_.-..- - ---- - --- - - -- ----
Title
i
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Sunshine Medical Supply, Inc.
IN SUM OF $
31575 Glendale Street
Livonia, MI 48150
$353.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year Encumbered I hereby certify that the attached invoice(s), or
25563 109996 42-390.12 $353.95
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
I which charge is made were ordered and
received except
Thursday, January 03, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or 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
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/31/12 109996 latex gloves $353.95
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