102115 PYSIO CONTROL CORP INDIANA RETAIL TAX EXEMPT Page 1 of 1
ciCity of Carrmniel
CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102115
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL,INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
'M APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
11/16/2018 242000 Video Laryngoscopes
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
31054
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.99
1 Each 11996-000394 McGrath 3.6V EMS Battery $53.94 $53.94
1 Each 11996-000413 McGrath MAC 1 Laryngoscope Blades, Box of 10 $142.68 $142.68
1 Each 11996-000414 McGrath MAC 2 Laryngoscope Blades, Box of 10 $142.68 $142.68
1 Each 11996-000415 McGrath MAC 3 Laryngoscope Blades, Box of 10 $142.68 $142.68
1 Each 11996-000416 McGrath MAC 4 Laryngoscope Blades, Box of 10 $142.68 $142.68
16 Each 11996-000393 McGrath MAC EMS Video Laryngoscope $2,300.10 $36,801.60
1 Each 11996-000398 McGrath X3 Laryngoscope Blades Box of 10 $248.82 $248.82
1 Each Shipping $185.00 $185.00
Sub Total $37,860.08
le C x
I
Send Invoice To: ,
Fire Department
2 Civic Square
Carmel, IN 46032- �'" v....,„;, `-,
PLEASE INVOICE IN DUPLICATE
DEPARTMENT l ACCOUNT S PROJECT Y PROJECT ACCOUNT AMOUNT
PAYMENT $37,860.08
SHIPPING INSTRUCTIONS *NP 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
'PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
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 James Crider 0\sk
TITLE Budget&Accreditation Manager Administration
CONTROL NO. 102115 CLERK-TREASURER \�