192893 12/15/2010 CITY OF CARMEL, INDIANA VENDOR: 242000 Page 1 of 1
0 ONE CIVIC SQUARE PHYSIO CONTROL CORP CHECK AMOUNT: $17,500.32
CARMEL, INDIANA 46032 12100 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693
CHECK NUMBER: 192893
CHECK DATE: 12/15/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351501 24161 411019061 17,500.32
rage: f Page I of I.
service Contract Billing age: 1
9 INVOICE
Mail payments only to this address: 411019061
12100 Collections center Drive
Chicago, IL 60693
Please reference Invoice Number on your check. 11/01/10
For Inquiries, Call toll free 1- 800 -426 -8047
10774101 10774201 Sold To: 10774201
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE 2 CIVIC SQUARE
CARMEL, IN 46032 CARMEL, IN 46032
UNITED STATES UNITED STATES
DD
11102110 12688 CSPPPI EALL71 dsouzcl 003120155002/mj
GRD 00143973 -00 Net 30 Days
ANNUAL 17500.32 T
FOR MAINTENANCE
AGREEMENT: PB11Y043
PERIOD: 11/01/10
10/31/11
sub Total 17500.32
Contact: Mark Hulett
Phone: 317- 571 -2663
Fax: 317 571 -2615
Terms:
10% DISCOUNT ON ACCESSORIES
5% DISCOUNT ON DEFIB ELECTRODES
PLEASE E -MAIL INVOICE ASAP TO
DENISE SNYDER AT dsnyder @carmel.in.gov
CCR 12 -22 -09
17500.32
Site: 20
D U P L I C A T E t*
9S 5 22
http:// mys tic. physio control. corn: 8080/ gadui/ FI3 'MLAdap ter" process SCgClenceid= 1092328.,. 12/3/2010
VO NO. WARRANT NO.
ALLOWED 20
Physio Control
IN SUM OF
12100 Collections Center Drive
Chicago, IL 60693
$17,500.32
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT #!TITLE AMOUNT Board Members
24161 411019061 43- 515.01 $17,500.32 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
DEC 1 3 2010
�X nv
P
S
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))
411019061 $17,500.32
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