225330 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 365720 Page 1 of 1
ONE CIVIC SQUARE COVITA
CARMEL, INDIANA 46032 30 WASHINGTON AVE SUITED CHECK AMOUNT: $89.88
HADDONFIELDNJ 08033 CHECK NUMBER: 225330
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 26421 V3151 89 . 88 WELLNESS PROGRAM
aV0 coVita Invoice
30 Washington Ave, Suite D
C treats�lta-
® Had donfield, NJ 08033 -Date Invoice No. `
tools for nt professionals (800)707-5751 09/30/2013 V3151
service @covita.net Terms,-. Due Date
hftp://www.covita.net Net 30 10/30/2013
Bill To Ship To
City of Carmel City of Carmel
Attn: Jim Spelbring Attn: Jim Spelbring
1 Civic Square 1 Civic Square
Carmel, IN 46032 Carmel, IN 46032 USA
Amount Due Enclosed
$89.88
Please detach top portion and return with your payment
------------------------------------------- -- ----------------------- ----- --- ----- ----------------------------
Ship Date Ship Via , ;` Customer.P.O.`.
09/30/2013 UPS Ground 26421
Item Description ; `: Quantity,'. Rate Amount.-
FP-MP/250 • Flatpak disposable cardboard mouthpieces, 250 2 37.00 74.00
individual mouthpieces packaged in 2 separate bags
12128- 12x1 2x8 • Box- 12x12x8 1 0.00 0.00
• NOTE: (1) SteriBreath MP included. '"New
product"
D
OCT 2 12013
By
Shipping & Handling Charges(may include haz-mat). SubTotal $74.00
NOTE: This invoice, and the contents of the shipment associated with it
will be presumed correct unless customer contacts us within 5 days of Shipping $15.88
the receipt of the shipment. Please inspect your shipment immediately. : .
Total
Federal Tax ID#:27-2887698
VOUCHER NO. WARRANT NO.
ALLOWED 20
coVita �S�2^�
IN SUM OF $
30 Washington Ave., Suite 0
Haddonfield, NJ 08033
$89.88
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26421 I V3151 ( 43-419.80 I $89.88 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
Monday, October 21, 2013
Director, HR
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))
09/30/13 V3151 $89.88
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