176211 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 354683 Page 1 of 1
ONE CIVIC SQUARE E M S A R INDIANA
CHECK AMOUNT: $512.00
CARMEL, INDIANA 46032 6745 PAYNE ROAD
INDIANAPOLIS IN 46203 CHECK NUMBER: 176211
CHECK DATE: 8/19/2009
DEPARTMENT ACC OUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 5201 137.00 OTHER CONT SERVICES
1120 4350900 5202 125.00 OTHER CONT SERVICES
1120 4350900 5203 125.00 OTHER CONT SERVICES
1120 4350900 5204 125.00 OTHER CONT SERVICES
EMSAR Indiana Invoice
6745 Payne Road
Date Invoice
Indianapolis, IN 46203
P 9 317 -697 -5379 EIN 35- 2152506 7/14/2009 5201
Bill To Ship To
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
Attn: Accounts Payable Attn:
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 TF 7/14/2009 On Site 08700200
Quantity Item Code Description Price Each Amount
1 Ferno P/M Bronze Ferno P/M Bronze 125.00 125.00
24 Mileage Mileage 0.50 12.00
Total $137.00
EMSAR Indiana Invoice
6745 Payne Road
Date Invoice
Indianapolis, IN 46203
P 317 697 -5379 EIN 35- 2152506 7/1412009 5202
Bill To Ship To
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
Attn: Accounts Payable Attn:
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 TF 7/14/2009 On Site 08700217
Quantity Item Code Description Price Each Amount
1 Ferno P/M Bronze Ferno P/M Bronze 125.00 125.00
Total $125.00
EMSAR Indiana Invoice
6745 Payne Road
Date Invoice
Indianapolis, W 46203
P 317- 697 -5379 EM 35- 2152506 7/14/2009 5203
Bill To Ship To
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
Attn: Accounts Payable Attn:
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 TF 7/14/2009 On Site 08700218
Quantity Item Code Description Price Each Amount
1 Ferno P/M Bronze Ferno P/M Bronze 125.00 125.00
Total 125.00
EMSAR Indiana Invoice
6745 Payne Road Date Invoice
Indianapolis, IN 46203
P 9 317- 697 -5379 EIN 35- 2152506 7/14/zoa9 szo4
Bill To Ship To
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel, IN 46032 Carmel, IN 46032
Attn: Accounts Payable Attn:
P.O. Number Terms Rep Ship Via F.O.B. Project
Net 30 TF 7/14/2009 On Site 08700219
Quantity Item Code Description Price Each Amount
I Ferno P/M Bronze Ferno P/M Bronze 125.00 125.00
Total $1.25.00
r
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))
5204 $125.00
5203 $125.00
5202 $125.00
5201 $137.00
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
20
Clerk Treasurer
VOU.GHER NO. WARRANT NO.
ALLOWED 20
EMSAR Indiana
IN SUM OF
6745 Payne Road
Indianapolis, IN 46203
$512.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #ITITLE AMOUNT Board Members
1120 5204 43- 509.00 $125.00 1 hereby certify that the attached invoice(s), or
1120 5203 43- 509.00 $125.00 bill(s) is (are) true and correct and that the
1120 5202 43- 509.00 $125.00
1120 5201 43- 509.00 $137.00 materials or services itemized thereon for
which charge is made were ordered and
received exce
AUG 17 2009
C 'olo
Fire Chief
Title
Cost distribution ledger classification if
claim Paid motor vehicle highway fund