209357 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 360209 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 ATTN: J ZIMMERMAN, ACCT REPTNG CHECK AMOUNT: $747.29
10330 N MERIDIAN ST SUITE 340 CHECK NUMBER: 209357
°M INDIANAPOLIS IN 46290
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 12919 747.29 SPECIAL DEPT SUPPLIES
St. Vincent Hospital Healthcare Center, Inc. StMincent Invoice
Attn: Jeremy Zimmerman
10330 N. Meridian, Suite 430 DATE INVOICE
Indianapolis, IN. 46290 -1024
5/14/2012 12919
BILL TO
Carmel Fire EMS
Attn: Accounts Payable
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased April 2012 Billed May 2012 747.29
Medical Supplies: 0.00
Transfer Drugs: 747.29
TOTAL: $747.29
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 $747.29
are paying on check/stub. Thank you!!
Inquiries: Jeremy Zimmerman Payments /Credits $0.00
317.583.3223
jrzimmer @stvincent.org Balance Due $747.29
VOUCHER NO. WARRANT NO.
St. Vincent Hospital ALLOWED 20
Attn: Jeremy Zimmerman, Acct. Reporting IN SUM OF
10330 N. Meridian Street, Ste. 430 N
Indianapolis, IN 46290
$747.29
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 I 12919 1 102 390.11 I $747.29 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
MAY 2 -1 7012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
12919 I $747.29
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