323870 04/06/18 CITY OF CARMEL, INDIANA VENDOR: 360209
.; � �l•: ONE CIVIC SQUARE ST VINCENT HOSPITAL
CHECK AMOUNT: $*****3,400.00*
CARMEL, INDIANA 46032 ATTN:KRISTINE BROWN,ACCT.RPTNG CHECK NUMBER: 323870
10330 N MERIDIAN ST SUITE 430 CHECK DATE: 04/06/18
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 R4467006 101036 1008024 3,400.00 02 REFILL UNITS
z '
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 360209
ST VINCENT HOSPITAL IN SUM OF$ CITY OF CARMEL
ATTN: KRISTINE BROWN,ACCT. RPTNG An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
10330 N MERIDIAN ST SUITE 430 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46290
Payee
$3,400.00
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
101036 1008024 44-670.06 $3,400.00 1 hereby certify that the attached invoice(s),or 3/29/18 1008024 $3,400.00
1120 Encumbered 102 1120 102
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
Thursday, March 29,2018
David Haboush
Fire Chief
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
St.Vincent Home Medical
2020 MERIDIAN ST. SUITE 180
ANDERSON, IN 46016-4337 Invoice
(765) 646 8366
Misc Customer
Print Date 3/29/2018 FIRE DEPT CARMEL
First Print 2/6/2018 2 Civic Square
Invoice 1008024 CARMEL,IN 46032
Order 236620
Account No.
Qty Date Description Charges/Debits Payments/Credits
4 02/02/2018 , RSCO04 $2,200.00
CONC HOME FILL
Bill to Cost center 8123
03/29/2018 Adjust Allowable Adjust Allowable $200.00
4 02/02/2018 RSCO26 $800.00
5L OXYGEN CONCENTRATOR
Bill to Cost center 8123
12 02/02/2018 HOMEFILLDPOST $600.00
SELF FILL D CYLINDERS
Bill to Cost center 8123
Total $3,600.00 $200.00
Balance $3,400.00
Payment Cash Check Charge PAY THIS AMOUNT : $3,400.00
Comments
Name
CC#
Expires
BT-INV4-79341 Page 1