193081 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 354683 Page 1 of 1
ONE CIVIC SQUARE E M S A R INDIANA CHECK AMOUNT: $886.69
CARMEL, INDIANA 46032 6745 PAYNE ROAD
INDIANAPOLIS IN 46203 CHECK NUMBER: 193081
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 SI -10708 886.69 OTHER CONT SERVICES
Dec 15 10 09:06a Phillip Schaney 317 788 -8550 p.2
EMSAR Indiana Duplicate Copy
67451E. Payne Rd. Invoice
Indianapolis, INI 46203
(317) 697 -0510
(317) 788 8550 Fax Customer Number I Date Invoice Numbe
jC10052 I 1219!2010 !SI -10708
Bill To: I Ship To:
Carmel Fire DeparlmenU24 Carmel Fire Department/24
Carmel Fire Department 2 Civic Square A Carmel Fire Department j
Accounts Payable 2 Civic Square
Carmel, IN 46032 Attn: I
Carmel, IN 46032
I I
I
Sbip Via Terms Du Date Sales Rep Customer PO Original Order Numbe
Wal In Net 3 0 j lI 01 17 ISR10003 t
Item No Qty 910 Ship Description Sales Price Disc Total
PM FERNO 1 0 1 PREVENTIVE MAINTENANCE 90.00 0 90.00
FERNO- WASHINGTON
PNI FERNO 4 0 4 PREVEI;TIVE'AC INTENANCE 125.60 0% 300.00
FERNO- WASHINGTON
1525003 1 0 1 35-VA )3-P CASTER WITH BRAKE WIWHEEL 235.44 0% 235.44
2748038 1 0 1 HUB AND TIRE 49.25 0% 49.25
MFLEAGE 24 0 24 MILEAGE FERNO-WASIHNGTON EMS 0.50 0% 1100
FERNO EMS
Total Item Count: Total Items Shipped: 31
Subtotal: 885.69
Freight: 0.00
Tax: 0.00
Totals 886.69
Amount Due: 586.69
Page 1
VOUCHER NO. WARRANT NO.
ALLOWED 20
EMSAR Indiana
IN SUM OF
6745 Payne Road
Indianapolis, IN 46203
$886.69
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# I Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 SI -10708 43- 509.00 $886.69 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 2 0 2Q 11J
r /F
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))
SI -10708 $886.69
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