205718 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 176650 Page 1 of 1
ONE CIVIC SQUARE KOORSEN PROTECTION SERVICE, INC CHECK AMOUNT: $53.54
CARMEL, INDIANA 46032 2719 N ARLINGTON AVE
INDIANAPOLIS IN 46218 -3300
CHECK NUMBER: 205718
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 2563543 53.54 REPAIR PARTS
ROAIR INV ®ICE
2563543 Dale of 12/30/2011 c-t
Oer
REMIT TO: Koorsen Fire Security N work:
2719 N Arlington Avenue
Indianapolis, IN 46218 -3322 12 3 0 2 011 SO 2281642 Date 01/24/2012
Invoice Date:
1 888 KOORSEN Include invoice on check. Due:
Cust ID 21CAR0002 Joo.a SERVICEII 0
Sold To: Location:
CARMEL FIRE DEPT CARMEL FIRE DEPT
2 CIVIC SQ 2 CIVIC SQ
CARMEL, IN 46032 CARMEL, IN 46032
21 -HOUSE 21 -HOUSE STOCK11
i.:.<.-_.::. ....'�.^rt^- �x.;:c= hc'.n_+a�Yt: wf >o-= au,:'L:w :^i_ :r.'.w.<":c"r ,:...or .,...�.o e:.,.._:.: r :arGS- +t&;..�.T.i"u:G2.:.:'.u .z..- az ?lvp...'2'_..r xe. .'�•'MxC'dis >.t `.:F_'r 4T i2w±1�
6.00 G04.50RING O -RING 4.5 GO 2.59 15.54
2.00 GOBLEEDERS SCREW,BLEEDER 16.00 32.00
1.00 99SHIP SHIPPING CHARGE -TX- 6.00 6.00
TOTAL SALES /SERVICES XMPN 0031201550 -020 53.54
TOTAL 53.54
Pay online www.koorsen.com. To pay by credit card, please phone or return to us:
Circle: VISA MC AMEX Card Number
Name on Card Expiration Date
Total Sales Taxable Sales Tax Amount Shipping Charge Invoice Total
53.54 0.00 0.00 53.54
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))
2563543 $53.54
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.
ALLOWED 20
IN SUM OF
4 Vt"tS IN
$53.54
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 I 2563543 42- 370.00 I $53.54 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
JAN 13 201
J_.
i
1
F ir e Chi
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund