101618 PHYSIO CONTROL CORP INDIANA RETAIL TAX EXEMPT Page 1 of 1
ciCity of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101618
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AN
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
4/25/2018 242000 EMS Supplies and Equipment
PHYSIO CONTROL CORP Fire Department
VENDOR 12100 COLLECTIONS CENTER DRIVE SHIP 2 Civic Square
TO Carmel, IN 46032-
CHICAGO, IL 60693-
PURCHASE ID BLANKET. CONTRACT PAYMENT TERMS FREIGHT
25402
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.06
2 Each 11171-000049 Rainbow DCI Adt Reusable Sensor 1 Box $556.80 $1,113.60
2 Each 11171-000050 Rainbow DCIP Pedi Reusable Sensor 1 Box $613.35 $1,226.70
1 Each 11996-000341 Rainbow R20-L Infant Adhesive Sensors(SpI2,SpCO and $622.05 $622.05
SpMet) 10/box
2 Each 11171-000037 RC-04 Patient Cable, 1 Box $220.98 $441.96
1 Each Shipping $65.00 $65.00
Sub Total $3,469.31
s
',
J
ff e.
s
Send Invoice To: �� i
Fire Department ,./
Via. \ / ;.
tea,
..,r /
2 Civic Square
Carmel, IN 46032- _ 9 „ .3U.
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
PAYMENT $3,469.31
SHIPPING INSTRUCTIONS '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
'SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 � `''�= " �
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Denise Snyder
TITLE Budget&Accreditation Manager C�
CONTROL NO. 101618 CLERK-TREASURER V�