247252 07/15/15 9, `" CITY OF CARMEL, INDIANA VENDOR: 368834
® 1• ONE CIVIC SQUARE FIRE SAFETY USA CHECK AMOUNT: $**..."310.00"
ROCHESTER CARMEL, INDIANA 46032 3253 19TH STREET NW CHECK NUMBER: 247252
'�,,�uH�o. ROCHESTER MN 55901 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 79569 310.00 REPAIR PARTS
FIRE SAFETY USA, INC. invoice
3253 19TH ST NW
- --— - -- --- ROCHESTER, MN 55901 Invoice#
mallow 507-529-8444: PHONE
- -- 79569
_ 507-529-8111: FAX
www.firesafetyusa.com
Date 7/9/2015
Bill To Ship To
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTML'NT
ACCOUNTS PAYABLE GARY CAR'T'ER
2 CARMEL CIVIC SQUARI7 2 CARMEL CIVIC SQUARE
CARMEL;IN 46032 CARMEL; IN 46032
P.O. No. Terms Due Date Rep Ship Via
GARY CARTER Net 30 8/8/2015 MARK UPS
Qty Item Description Price Each Amount
1 75014533 #1-1201-25N1-1-25N1-1:2.5"FEMALE NI-I X(2)2.5"MALE NH 295.00 295.00T
OUTLETS
I SHIPPING SHIPPING&HANDLING 15.00 15.00T
A'TTENT'ION:GARY CARTER
Choose FSUSA GOLD Services: Subtotal
$310.00
Mobile Service- We come to You!
EVT Certified Mechanics, Fire Apparatus Services and Repairs Sales Tax (0.0%)
Mobile ISO Pump Testing Nvith our Draft Commander Trailer! $0.00
Fire Truck Chassis Servicing,Fire Pump Servicing
Extrication Tool Servicing Payments/Credits $0.00
Breathing Air Compressor Servicing
Ambulance Servicing and Repairs ; Balance Due $310.00
Police/Squad Car Upfitting and Installs
=----------------------------------------------------------------------
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))
79569 $310.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fire Safety USA
IN SUM OF $
3253 19th Street NW
Rochester, MN 55901
$310.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 79569 42-370.00 $310.00 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
JUL 13 2015
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund