164773 10/16/2008 CITY OF CARMEL, INDIANA VENDOR: 00352605 Page 1 of 1
ONE CIVIC SQUARE INGENIX
CARMEL, INDIANA 46032 PO BOX 27116 CHECK AMOUNT: $150.91
SALT LAKE CITY UT 84127 CHECK NUMBER: 164773
CHECK DATE: 10/16/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUN DESCRI
�'1120 4355200 9837096 150.91 SUBSCRIPTIONS
'I
Ingenix INGENIX.
PO BOX 27116 1.800.464.3649, Option 1
Salt Lake City, UT 84127 -0116 FAX 601.982.4033
Federal Tax ?D# 54- 1526076
Original Invoice 9837096
Customer 1715996
2736473IIA0073701
Bill To: Carmel Fire Dept Ambulance Services
Accounts Payable
2 Civic Square
Carmel, IN 46032 -7543
Ship To: Carmel Fire Dept Ambulance Services
Becky Lannan
2 Civic Square
Carmel, IN 46032 -7543
.Invo<i "ce bafe' i:Our `Order; Number, Ordered''B�'
09/26/2008 1 5871643 Becky Lannan Net 15 Days
Purchase 'Orderk
Numberl Order Date' Sa Person ,k,Shi' merif r-ack
07/15/2008 E4M iZ8419320368059896 1
ty' Quant i,,t ...."a^
Ord Sh d `I tero '.il k` ,Descr i 't 1 on ..Unit' Pi^ i 66.' D i'scount. F Net A mount_
1 1 0053 I STANDARD SHIPPING -TOTAL ORDER CHRG 10.95 .000% 10.951
ISBN:1563374781
1 1 3539 1 ICD -9 EXPERT HOSP 3 VOL UPDATEABLE 174.95 20.000% 139.96
ISBN:9781601510389
Non Taxable Subtotal 150.91
Taxable Subtotal .001
Tax .00
Invoice Total 150.91
Pa ment Credit 00
Total Due 150.91
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))
9837096 Billing Codes $150.91
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
VOUCHER NO.. WARRANT NO.
Ingenix ALLOWED 20
IN SUM OF
P.O. Box 27116
Salt Lake City, UT 84127
$150.91
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 9837096 43- 552.00 $150.91 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
OCT 13 2008
r
P
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund