190350 09/29/2010 CITY OF CARMEL, INDIANA VENDOR: 176650 Page 1 of 1
ONE CIVIC SQUARE KOORSEN PROTECTION SERVICE, INC CHECK AMOUNT: $5.00
CARMEL, INDIANA 46032 2719 N ARLINGTON AVE
INDIANAPOLIS IN 46218 -3300 CHECK NUMBER: 190350
CHECK DATE: 9/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 2232291 5.00 REPAIR PARTS
REMIT TO:
1� O A 1 4 '�a�'�� Koorsen Fire Security, Inc
2719 N. Arlington Ave.
www.koorsen.com Indianapolis, IN 46218 -3322
Please include invoice
OW E: Number on check.
#NC.
INVOIE SERVIC OUST.
A DIVISION OF KOORSEN NuMaE R 2 3 2 2 9 1 DATE b /30/2010 P.O. NO.
Phone 812 336 -4022 INVOICE SERV DATE DUE
Toll Free 800 245 -0269 DATE 09/09/2010 ORD. 01 5233 10/04/2010
InvoicetciUSt ID 21CAR0002 TERMS: Net 25 Days Job SERVICE21 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 I
1.00 CDM9403 KIT,REPAIR,LINE VLV 3506- 10,GO10A,3506 -13 5.00 5.00
TOTAL SALES /SERVICES 5.00
TOTAL 5.00
To pay by credit card, please phone or return to us:
Card number____
Visa MasterCard American Express
Name on card Expiration date I
Signature X
TOTAL SALES TAXABLE SALES TAX AMOUNT SHIPPING CHARGE PLEASE PAY
n n
THIS AMOUN T
Federal ID 355TM9 A servi2 (n� Ohl rge of 12% per month P 899annual) will be charged on past due accounts. 5 .00
KFPA 001 (8108) CUSTOMER COPY
VGU NO. WARRANT NO.
ALLOWED 20
00 IN SUM OF
�4740 S
$5.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 2232291 42- 370.00 $5.00 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 2 7 2010
/KeL, fV
d
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
2232291 $5.00
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and l have audited same in accordance
with IC 5- 11- 10 -1.6
20
Clerk- Treasurer