175730 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 131135 Page 1 of 1
ONE CIVIC SQUARE HOOSIER FIRE EQUIPMENT INC
CARMEL, INDIANA 46032 4009 MONTOALE PARK DRIVE CHECK AMOUNT: $172.59
ss VALPARAISO IN 46383
CHECK NUMBER: 175730
CHECK DATE: 8/6/2009
DE PARTMENT ACC OUNT PO N UMBER INVOICE NUMBE AMOUNT DESCRIPTION
1120 4237000 00717718 172. REPAIR PARTS
r',
INVOICE PAGE: 1
Hoosier Fire Equipment, Inc. INVOICE NUMBER: 0071718 -IN
4009 Montdale Park Drive INVOICE DATE: 07/29/09
Valparaiso, Indiana 46383
ORDER NUMBER: 0104325
ORDER DATE: 07/27/09
(219) 462 -1707 SALESPERSON House
CUSTOMER NO: CARM01
SOLD TO: SHIP TO:
Carmel Fire Department Carmel Fire Department
2 Civic Square 2 Civic Square
Carmel IN 46032 -7543 Carmel IN 46032 -7543
CONFIRM TO:
CUSTOMER P.O. SHIP VIA F.O.B TERMS
E -44 UNITED PARCEL Net 10
ITEM NO. UNIT ORDERED SHIPPED BACK ORD PRICE AMOUNT
HQ -109 EACH 1.00 1.00 0.00 19.55 19.55
HOOSIER DYNA -LITE SILVER SWIVEL BASE
/SORDER EACH 1.00 1.00 0.00 18.00 18.00
#S1, HOOSIER DYNA -LITE LIGHT SOCKET
/SORDER EACH 1.00 1.00 0.00 18.00 18.00
#S1 -1, HOOSIER DYNA -LITE TENSION LIGHT SOCKET
A *2.50 EACH 2.00 2.00 0.00 55.00 110.00
HOOSIER 3" OFF -SET BRACKET WHSE: 000
TAXABLE .00
NON TAXABLE 165.55
NET INVOICE: 165.55
SALES TAX: .00
FREIGHT: 7.04
INVOICE TOTAL: 172.59
Prescribed by State Board of Accounts I 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))
00717718 Parts E41 $172.59
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Hoosier Fire Equipment
IN SUM OF
4009 Montdale Park Drive
Valparaiso, IN 46383
$172.59
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 00717718 42 370.00 $172.59 I 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
i -3 9009
L 401
1"
0
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund