180271 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 360209 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CHECK AMOUNT: $1,472.42
CARMEL, INDIANA 46032 ATTN: MARILYN WHEELER, ACCT REPTNG
10330 N MERIDIAN ST SUITE 340 CHECK NUMBER: 180271
INDIANAPOLIS IN 46290
CHECK DATE: 12/812009
DEPARTMENT ACCOUNT PO NUM INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 11308 1,472.42 SPECIAL DEPT SUPPLIES
St. Vincent Hospital Healthcare Center, Inc. Invoice
Attn: Marilyn Wheeler, Acct Reporting
10330 N. Meridian St., Suite 430 North DATE INVOICE
Indianapolis, IN 46290 -1024 11/18/2009 11308
BILL TO
Carmel Fire EMS
Attn: Accounts Payable
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased October 2009 billed in November 2009 1,472.42
Medical Supplies: 292.16
Transfer Drugs: 1,180.26
TOTAL: $1,472.42
See Attached
Any questions regarding the above charges can be directed to:
Pete Dillman, Program Director Emergency Medical Services
Phone: 317 338 -7272
1- 8766 -1464. Please notate invoice number that you Total $1472.42
are paying on check/stub. Thank you!!
Inquiries: Marilyn Wheeler Payments /Credits $0.00
Phone: 317 -583 -3297
Fax: 317 -583 -3285 Balance Due $19472.42
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))
11308 $1,472.42
I
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
St. Vincent Hospital
Attn: Marilyn Wheeler, Acct. Reporting IN SUM OF
10330 N. Meridian Street, Ste. 340
Indianapolis, IN 46290
$1,472.42
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 11308 102 390.11 $1,472.42 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
DEC -1 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund