249337 09/09/15 CITY OF CARMEL, INDIANA VENDOR: 176650
ONE CIVIC SQUARE WORSEN ENVIRONMENTAL SERVICES CHECK AMOUNT: $....*1,340.00*
CARMEL, INDIANA 46032 2719 N ARLINGTON AVE CHECK NUMBER: 249337
INDIANAPOLIS IN 46218-3300 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351501 3623884 1,340.00 EQUIPMENT MAINT CONTR
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P R 0 A I R INVOICE
3 6 2 3 8 8 4 Dale of oust.
REMIT TO:Koorsen Fire&Security No.: work: order
2719 N Arlington Avenue #:
Indianapolis,IN 46218-3322 Invoice Date: 09/02/2015 SO#: 3623884 Date 09/28/201S
1-888-KOORSEN Include invoice#on check. Due:
Cust ID 21CAR0002 JOBH SERVICE21 / 6
Sold To: Location: c
CARMEL FIRE DEPT CARMEL FIRE DEPT - RESCUE 45
2 CIVIC SQ 10701 N COLLEGE AVE
f
CARMEL, IN 46032 INDIANAPOLIS, IN 46280
21-HOUSE
:.
ANNUAL BILLING AIR SAMPLE SERVICE 570. 00
OCTOBER 01, 2015 THRU SEPTEMBER 30, 2016
ANNUAL BILLING AIR COMPRESSOR MAINT 770 . 00
OCTOBER 01, 2015 THRU SEPTEMBER 30, 2016
Total 1, 340 . 00
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Pay online @ www.koorsen.com. To pay by credit card,please phone or return to us:
Circle:VISA MC AMEX Card Number
Name on Card Expiration Date
Total Sales Taxable Sales Tax Amount Shipping Charge Invoice Total '--> '
1, 340 . 00 1, 340 . 00 0 . 00 1, 340 . 00
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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))
3623884 $1,340.00
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
Koorsen Fire & Security
Pro-Air IN SUM OF $
2719 N. Arlington Avenue
Indianapolis, IN 46218
$1,340.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 3623884 43-515.01 $1,340.00 1 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
i I --�_
NXIN,) �.
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund