249845 09/23/15 �.Coq .
%' *f� CITY OF CARMEL, INDIANA VENDOR: 368918
.�; ® � ONE CIVIC SQUARE PENN CARE INC.
CHECK AMOUNT: $*******743.40*
�., =a CARMEL, INDIANA 46032 1317 NORTH ROAD CHECK NUMBER: 249845
M�liaN�o, NILES OH 44446 CHECK DATE: 09/23/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 85606 743.40 SPECIAL DEPT SUPPLIES
Invoice #85606
1317 North Road
Niles, OH 44446 PO: Tom Small
`Z 800-392-7233 Order Date: 8/24/2015
Public Safety Technology sales@penncare.net Invoice Date: 8/26/2015
Terms:
Ship Method: UPS Ground
Bill To: Ship To:
Carmel Fire Dept. Carmel Fire Dept.
540 W 136 st 540 W 136 st
Carmel, IN 46032 Carmel, IN 46032
. a
.:wE!`':kes"��:Y. t :°�rv",ig7:e,;'�.c' .::�. •,','�-.en5y t.; ,,R'Yv:•T"T"!i".�� '6.
Carmel Fire Dept.
70 70 0 MF-296L Gloves, MiclKnight Nitrile Large 10.62 each 743.40
bx/100
$743.40
Subtotal $743.40
Shipping
Tax @
TOTAL $743.40
Payments
Credits
Page 1 of 1
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))
85606 $743.40
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
$743.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 85606 102-390.11 $743.40 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
CCP 2 20x5
g A�a/f
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund