190061 09/15/2010 ±y CITY OF CARMEL, INDIANA VENDOR: 176650 Page 1 of 1
ONE CIVIC SQUARE KOORSEN PROTECTION SERVICE, INC
CHECK AMOUNT: $1,130.00
CARMEL, INDIANA 46032 2719 N ARLINGTON AVE
INDIANAPOLIS IN 46215 -3300 CHECK NUMBER: 190061
CHECK DATE: 9115/2010
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351501 24115 2230832 1,130.00
REMIT TO:
Q A INVO Koorsen Fire Security, inc
2719 N. Arlington Ave.
9 www.koorsen.com Indianapolis, IN 46218 -3322
Please include invoice
y�/ E Number on check.
INVOICE SERVICE CUST.
A DIVISION OF KOORSEN NUMBER 230832 DATE P.O. NO,
Phone 812 -336 -4022 INVOICE SERV. DATE DUE
Toll Free 800-245-0269 DATE 09/08/2010 oRD.�230832 10/03/2010
InvoicetcCUSt ID 21 CAR0002 TERMS: Net 25 Days Job SERVICE21 J 6
Service Location:
CARMEL FIRE DEPT CARMEL FIRE DEPT RESCUE 45'
2 CIVIC SQ 10701 N COLLEGE AVE
CARMEL IN 46032 INDIANAPOLIS, IN 46280
QUANTITY ITEM DESCRIPTION UNIT PRICE
ANNUAL BILLING AIR SAMPLE SERVICE 450.00
OCTOBER 01, 2010 THRU SEPTEMBER 30, 2011
ANNUAL BILLING AIR COMPRESSOR MAINT 680.00
OCTOBER 01, 2010 THRU SEPTEMBER 30, 2011
Total 1,130.00
To pay by credit card, please phone or return to us:
Card number____
Visa MasterCard American Express
Name on card Expiration date
Signature X
TOTAL SALES TAXABLE SALES TAX AMOUNT SHIPPING CHARGE PLEASE PAY
9 n THIS AMOUNT
FA .I1D�s A QAa4s 1 i �AtcgQharge of 12% per month (f%`hgnual) will be charged on past due accounts. 1,130.00
KFPA 001 (8108) CUSTOMER COPY
VOUCHER NC. WARRANT NO.
ALLOWED 20
Pfe�cir
IN SUM OF
j
-Bta
$1,130.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
24115 2230832 43- 515.01 $1,130.00 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
SEP 13 2010
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
k
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))
2230832 $1,130.00
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