HomeMy WebLinkAbout253951 01/26/16 W 4`q
J�% '� CITY OF CARMEL, INDIANA VENDOR: 368918
`q® ONE CIVIC SQUARE PENN CARE INC. CHECK AMOUNT: $'•"•`"'590.00'
a CARMEL, INDIANA 46032 1317 NORTH ROAD CHECK NUMBER: 253951
'M '?' NILES OH 44446 CHECK DATE: 01/26/16
ETON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 87976 590.00 SPECIAL DEPT SUPPLIES
Invoice #87976-
1317 North Road
Vii.: Niles, Oti 44446 PO: Tom
PublicasieryK aosy 800-392-7233 Order Date: 1/5/2016
Technsales@penncare.net Invoice Date: 1/5/2016
Terms; Net 30
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
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+3
10 10 0 PC-1057209 Flow-Safe II CPAP with Large Adult 59.00 each 590.00 d
$590.00
Subtotal $590.00
Shipping
Tax @
TOTAL $590.00
Payments
Credits
TM-
-SSS.
,Page 1 of 1
rescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
Ln invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by
Thom, 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))
87976 $590.00
I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Penn Care Inc.
IN SUM OF$
1317 North Road
Niles, OH 44446
$590.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 87976 102-390.11 $590.00 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
n A
k - �
P(NIAUy1 i'1 Uti(f
Fire Chief
Title
1
Cost distribution ledger classification if
claim paid motor vehicle highway fund