177712 09/29/2009 F CITY OF CARMEL, INDIANA VENDOR: 00352605 Page 1 of 1
t. ONE CIVIC SQUARE INGENIX
CARMEL, INDIANA 46032 PO BOX 27116 CHECK AMOUNT: $135.90
SALT LAKE CITY LIT 84127
CHECK NUMBER: 177712
CHECK DATE: 9/29/2009
DEPA RTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 435520.0 10114731 135.90 SUBSCRIPTIONS
In enix INGENIX.
9
i�p PC BOX 27116 1.800.464.3649, Option 1
Salt Lake City, UT 84127 0116 FAX 801.982.4033
Federal Tax iD# 41- 1858498
Original Invoice 10114731
Customer 1715996
2526473IIA0248901
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
€hnvoi'ce' Date ..:Our. Order' Number uwOrdere`d By
09/08/2009 1 6112376 Becky Lannan Net 15 Days
Shi "pment. r- 66k`iEn
sP.urchase�0rder, ".,Number ��Order,�gDate {.:Sal "e`s��`Person a °Number r�.,�
07/31/2009 EZ9
4uantlty s�
{d Descr l pt l on.. {k w, Un i t Pr ice P, I scount Ne.tmr,'dmount,
1 I 1 I 3539 ICD -9 Expert Hosp 3 Vol Updateable 124.95 .000% 1 124.95
ISBN:9781601511300
1 1 0053 Standard Shipping -Total Order Chrg 10.95 .000% 10.95
ISBN:1563374781
100% Money Back Guarantee
if our merchandise- ever fails to meet your expectations,
please contact our customer service department at the 800 I Non- Taxable Subtotal 10.95
listed on this invoice for an immediate response. I Taxable Subtotal _?MBA/ 1 n97_7
Software: Credit will be granted for unopened packages only i
FOB Ingenix warehouse. Title and risk of loss passes to Tax
buyer upon delivery to carrier. Invoice Total
Payment /Credit .00{
Total Due 144.65
i
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))
10114731 $135.90
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. WARR ANT N
ALLOWED 20
Ingenix
IN SUM OF
P.O. Box 27116
Salt Lake City, UT 84127
$135.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT
Board Members
1120 10114731 43- 552.00 $135.90 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
SEP 2 9 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund