211263 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 354683 Page 1 of 1
ONE CIVIC SQUARE E M S A R INDIANA CHECK AMOUNT: $90.00
CARMEL, INDIANA 46032 6745 PAYNE ROAD
INDIANAPOLIS IN 46203 CHECK NUMBER: 211263
CHECK DATE: 7/3112012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 SI-11604 90 . 00 REPAIR PARTS
EMSAR Indiana
6745 E.Payne Rd. Invoice
Indianapolis, IN 46203
(317)213-5262
(317)357-1059 Fax Customer Number Date Invoice Number
C10052 1 7/18/2012 1 ISI-11604
Bill To: Ship To:
Carmel Fire Department/24 Carmel Fire Department/24
Carmel Fire Department 2 Civic Square Attn: Carmel Fire Department
Accounts Payable 2 Civic Square
Carmel, IN 46032 Attn: Accounts Payable
Carmel, IN 46032
Ship Via Terms Due Date Sales Rep Customer PO Original Order Number
--- �LJPS-Ground Due-on-Receipt 7/18/2012 -�
Item No Qty B/O Ship Description Sales Price Disc Total _
Refurbished rail 1 0 1 Refurbished rail Nv/core 90.00 0% 90.00
w/core
Total Item Count: 1 Total Items Shipped: 1
Subtotal: 90.00
Freight: 0.00
Tax:'Z �4, 0
Total: 4 -
Amount Due: q&•'0
Page 1
VOUCHER NO. WARRANT NO.
ALLOWED 20
EMSAR Indiana
IN SUM OF $
6745 Payne Road
Indianapolis, IN 46203
$90.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
1120 I SI-11604 I 42-370.00 J $90.00 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
JUL 3 o M2
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
3rescribed by State Board of Accounts City Form No.201(Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
Nhom, 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))
SI-11604 $90.00
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