178147 10/14/2009 a CITY OF CARMEL, INDIANA VENDOR: 363420 Page 1 of 1
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NORTHBROOK IL 60065 CHECK NUMBER: 178147
CHECK DATE: 10/14/2009
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(munjcipa1, county or state)? 01 (J Under 2,500 appprve purchases for your department?
1 d 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
04 X5,001- 50,000
2. Rank�or Title: 05 50,001- 100,000 7. Other relationship to the fire service:
01 El Chief of Department 06 100,001 500,000 22 Industrial, institutional, military,
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03 Other Officer with special fire prevention or
04 Firefighter 5. Func9on (check ALL that apply): suppression requirements
05 Training Officer 01 K anagement 23 Fire Prevention and fire protection
06 Other 02 wining engineering firm, fire consultant,
03 �����jjjjj�revention arson investigation organization or
3. Volunteer or Paid: 04 Suppression insurance company
01 ❑}'volunteer 05 on �Investi ati
02 Paid g 21 ❑Other government dept or agency
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ALLOWED 20
Fire Engineering
IN SUM OF
P.O. Box 3498
Northbrook, IL 60065
$29.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 43- 552.00 $29.95 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
A e
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)
-Vr
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))
$29.95
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