193091 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 363420 Page 1 of 1
1 ONE CIVIC SQUARE FIRE ENGINEERING CHECK AMOUNT: $29.00
CARMEL, INDIANA 46032 PO BOX 3498
o �o NORTHBROOK IL 60065 CHECK NUMBER: 193091
CHECK DATE: 12/22/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4355200 319232 29.00 SUBSCRIPTIONS
0 0 To renew complete and mall this form or
call 800-582-6949.
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Account 319232 Expire Date: 02r2011 5 reasons to renew your subscription
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Help us serve you better by answering the questions below:
I. Are you a member of a fire department 4. Population Served by Department 6. Do you purchase, recommend, specify or
(municipal, county or state)? 01 Linder 2,500 approve purchases for your department?
1 Yes (go to questions 2 -6) 02 2,501- 10,000 1 Yes
0 No (go to question 7) 03 10,001- 25,000 0 No
07 25,001 50,000
2. Rank or Title: 07 50,001 100,000 7. Other relationship to the fire service:
Of ❑Chief of Department 09 100,001- 500,000 22 Industrial, institutional, military,
02 Stall' Chief 10 Over 500,000 airport, high -rise, or other organization
03 CJ Other Officer with special fire prevention or
04 Firefighter 5. Function (check ALL that apply):
suppression requirements
05 Training Officer 01 Management 23 Fire Prevention and fire rotection
06 D Other 02 :1 Training p
03 ❑Prevention engineering Firm, fire consultant,
3. Volunteer or Paid: 04 Suppression arson investigation organization
01 D Volunteer or insurance company
05 Investigation 71 agency
Other government dept or a
0_ ❑Paid 06 ❑Maintenance g p g y
03 ❑Combination Paid/Volunteer 24 Fire equipment manufacturer
07 Communication 25 Fire equipment distributor
08 Public Education 26 School
09 EMS 27 Public Library
10 Flazmat 28 Fire Association, fire museum, TV, radio
I1 Rescue 29 Other
12 Other
VOUCHER NO. WARRANT NO.
ALLOWED 20
Fire Engineering
IN SUM OF
P.O. Box 3498
Northbrook, IL 60065
$29.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT /TITLE AMOUNT Board Members
1120 319232 43- 552.00 $29.00 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
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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))
319232 $29.00
1 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
1 20
Clerk- Treasurer