248974 08/26/15 f CITY OF CARMEL, INDIANA VENDOR: 368918
ONE CIVIC SQUARE PENN CARE INC."' CHECK AMOUNT: $"''"*'697.00'
,. i4 CARMEL, INDIANA 46032 1317 NORTH ROAD CHECK NUMBER: 248974
.�; ® :,
+*,'ON��� NILES OH 44446 CHECK DATE: 08/26/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 20610 392.00 AUTO REPAIR & MAINTEN
102 4239011 85312 305.00 SPECIAL DEPT SUPPLIES
� �® / 1317 North Road
``
L Niles, Ohio 44446
U Public Safety Technology
330-544-0777 Invoice
www.penncare.net
Invoice #: 00020610
Bill To: Ship To:
City of Carmel City of Carmel
One Civic Square Fire Department
Carmel, IN 46032-2584 2 Carmel Civic Square
USA Carmel, IN 46032
Salesperson P.O. number Ship Via Ship date Terms Date Page
Tony Crum Net 30 8/12/15 1
Quantity Item number Description Price UoM Amount
1 6768-CH Changes made in build $392.00 $392.00
process
Subtotal $392.00
Freight $0.00
Tax $0.00
Total $392.00
Applied $0.00
Balance $392.00
Invoice #85315
1317 North Road P®:
Niles, OH 44446
800-392-7233 Order Date: 7/24/2015
Public Safety Technology sales@penncare.net Invoice Date:,8/10/2015
Terms: Net 45
Ship Method: Drop Ship
Bill To: Ship To:
Carmel Fire Dept. Carmel Fire Dept.
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
. �..
Carmel Fire Dept.
1 1 0 MT-M5101 OMNI Pro (ICB) Infection Control 305.00 bag 305.00
Bag Dark Gray Vinyl
$305.00
Subtotal $305.00
Shipping
Tax @
TOTAL $305.00
Payments
Credits
Page 1 of 1
i
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))
85312 $305.00
20610 $392.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Penn Care Inc.
IN SUM OF $
1317 North Road
Niles, OH 44446
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 85312 102-390.11 $305.00 1 hereby certify that the attached invoice(s), or
1120 20610 43-510.00 $392.00 bill(s) is (are)true and correct and that the
\meq materials or services itemized thereon for
which charge is made were ordered and
received except
AUG 2 4 205
f1
1
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund