170631 04/01/2009 CITY OF CARMEL, INDIANA VENDOR: 362273 Page 1 of 1
ONE CIVIC SQUARE XTREME RESCUE, INC. CHECK AMOUNT: $718.00
e CARMEL, INDIANA 46032 P 0. Box 252
ROSCOE IL 51073 CHECK NUMBER: 170631
<ron
CHECK DATE: 4/1/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 R4356003 12629 20080030 718.00 ESCAPE BELTS
r ui lko
I Xtreme R Inc. j 1N® !I]IEE
614 State Street
Cherng Valley. IL. 61016 20080030
Phone 773- 296 -OB73
Fax 773- 388-2B33
S
ILL S H IP "T
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
ATTN: Denise
P.O. NO.
SHIPPE13 T®DAY5 DATE
Verba 12/12/2008 12/12/2008
I TY .DESCRIPTI 1'RIICE TO
5 Yellow LadderlEscape Belt 50" 70.00 350.00
5 Tower Strap 6' with Elk River Zorber 70.00 350.00
Shipping 18.00 18.00
Net 30 1/11/2009 $718.00
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 invoices) or bill(s))
20080030 Ladder Belts $718.00
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. 01ARRANT N
ALLOWED 20
Xtreme Rescue, Inc.
IN SUM OF
P.O. Box 252
Roscoe, IL 61073
$718.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
12629 20080030 43 560.03 $718.00 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
LIAR 3 D 2009
z �s-
r
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund