225302 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 361537 Page 1 of 1
yf ONE CIVIC SQUARE CARDIAC SCIENCE CORP
CARMEL, INDIANA 46032 CHECK AMOUNT: $208.77
PO BOX 83261
CHICAGO IL 60691-0261 CHECK NUMBER: 225302
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239012 25429 1591473 208 . 77 DEFIBRILL PADS
REMIT TO: INVOICE —
Cardiac Science Corporation Invoice No.1591473 —
MR I (�v� PO Box 83261 —
TM v vChicago IL 60691-0261 Page 1 of 1
Date: 10/01/2013
BIII to: CITY OF CARMEL Ship to: CARMEL POLICE DEPARTMENT
1 CIVIC SQ 3 CIVIC SQ
ACCOUNTS PAYABLE CARMEL, IN 46032-2584
CARMEL, IN 46032-2584
_yCustomer No_ Sales Order No -� Cust$PO/Refie�ence sSaies Perso � —
86999 B001178431 25429 PFLUGNER, TROY
,�,;� FOB�� �.�_ . Terms „��-,_� �i .�Curr•ency�
FOB Orgin net 30 USD US Dollars
ia W Item 09sc i tion U/ Qty Ord�� Qty Shpt Unit Price out '
Ship Date TrackmgkN°� ��. S/N .y
9131-001 ELECTRODES, DEFIBRILLATION AED, G3 EA 6 6 32.00 192.00
10/01/2013 523501260415611
Contact info: Net Sale Misc Chg Ship &.Handling, '£ Tax _ P�epaldAmt;
Customer care phone: 1-800-426-0337 192.00 0.00 16.77 0.00 0.00
Customer care e-mail: care @cardiacscience.com
Credit services phone: (262)953-7676
Credit services e-mail: AmOUnt°
creditservices @cardiacscience.com 20$.77
Fed Tax ID: 94-3300396
RI-130251852610559889-64-192
INDIANA RETAIL TAX EXEMPT PAGE
Ci o Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
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
Cardiac Science Carp Carmel Police Department
VENDORD@Spt.M87 h. TOIP Civic Square
P.O. Box '12MM Camel, IN 40
Dallas. TX 76392-0587 (31' 1 F37ie
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42 A2
6 Each Adult Defibrillation Pads 9939-009 $32.00 $992.00
y
Sub Total: $192.00
mj
CJa
3 `•.
La
FBI
Send Invoice To:
7
Carmel Police Department
Attn'. Teresa Anderson
3 Civic Square
Carmel, IN 46M2m PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $992,{Itd
t'
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
/JI I NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY .� /:. ` •-
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL �.
SHIPPING LABELS. //
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE / 'k of at PA1Ir+0
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT rT��HERETTO�.
2,b`�Z_.j CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
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
20
............._....................-.......................................--...........--.........-........._....................._--__................................_......_.............-....................-...............
Signature
........................................................................_....................._-................-..............................-..............-.
_..._..--....._.._.._........... Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
Cardiac Science Corp ALLOWED 20
Dept. 0587 IN SUM OF $
P.O. Box 120587 _
Dallas, TX 75312-0587
$208.77
ON ACCOUNT OF APPROPRIATION FOR -
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25429 I 1591473 I 42-390.12 I $208.77 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
Thursday, October 17, 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))
10/01/13 1591473 defibrillation pads $208.77
I 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