216508 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 365681 Page 1 of 1
ONE CIVIC SQUARE VIDACARE
e 4 CHECK AMOUNT: $733.68
CARMEL, INDIANA 46032 DEPT 2474
`o PO BOX 122474 CHECK NUMBER: 216508
DALLAS TX 75312-2474
CHECK DATE: 1115/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 67071 733 . 68 SPECIAL DEPT SUPPLIES
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INVOICE
Defining the field of Intraosseous Medicines'' INVOICE No. INV.DATE COST.NO• GLN.�O. PG Please remit payments to: 67071 1/10/2013 14753
Dept 2474 PO Box 122474
Dallas, TX 75312-2474
BILI.TO
SFIIP•ro
Carmel Fire Department Carmel Fire Department.
Attn:Accts Payable
2 Civic Square Attn: Receiving
Cannel IN 46032 2 Civic Square
Carmel IN 46032
SHIPPED DATE PURCHASE ORDER NO. SHIP VLF
1/10/2013 INCO'rERA1S TERJIS PA I'M DUE BY
01102013EM UPS Ground
JI
FOB
SALESPERSON Net 30
2/09/2013
EDLV L
Courtney DeWitt PHONE N
con rt ney.dewitt«vidacare.corn ElN
REMAR 317-517-6457 74-2899035
KS
Based On Sales Orders 60575.Based On Deliveries 65709. TRACKING NO.
IZAOIR830347586086
ITEM NO.
DESCRIPTION
QTl'SHIPPED BACK ORDER
9065 G3 Vascular Access Pack TOTA
9066 L!_- I0 UNIT PRICE .00 L
0 $20Stabilizer $300.00
8034 100 0
E!-Stabilizer IFU $400.00
I $4.00
0 $0.00 $0.00 j
SUBTOTAL $700.00
DISCOUNT $0.00
FREIGITr $33.68
TAX $0.00
TOTAL INVOICE
AMOUNT PAII)ON INVOICE
$0.00
PLEASE REMIT THIS AMOUNT S733.68
I
Claims as to
Price. shortage or otherwise, must be reported within 7 days of a shipping date. Products may not be returned without prior approval and are subject to a 25%
125\oc`mg See.behtvery and acceptance of the items listed herein represents an agreement by purchaser that the obligation presented on the related invoice is due and payable at the
office of the company shown above within 30 days from the date of the invoice.Custom products are not returnable.
Contact us at Tel 866-479-8500 Email'.VASales @vidacare.com Website:www.Vidacare.com
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))
67071 Misc. EMS Supplies $733.68
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.
ALLOWED 20
Vidacare
Dept. 2474
IN SUM OF $
PO Box 122474
Dallas, TX 75312-2474
$733.68
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1120 I 67071 102-390.11 I $733.68 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
JAN 14 2013
PIVI
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund