211379 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 366429 Page 1 of 1
a ONE CIVIC SQUARE MID—AMERICA FIRE&SAFETY LLC CHECK AMOUNT: $32.18
CARMEL, INDIANA 46032 4001 N ST JOSEPH STREET
EVANSVILLE IN 47720 CHECK NUMBER: 211379
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 12844 32 . 18 REPAIR PARTS
®-eO°• •(� lipid America Fire & Safety LLC
• � 4001 N. St. Joseph Ave. Date Invoice#
Evansville, IN 47720
P 7/13/2012 12844
H 812-423-5505
FX 812-423-5553
Carmi Fire Dept.
501 3rd Street
Carmi. 1162821
P.O. No. Terms Rep
Net 30 House
Item Description Qty Rate U/M Amount
Labor Labor 0.5 45.00 22.50
Outbound Frt Outbound Fri 1 9.68 9.68
Item Q-1 blade pin assembly (No Charge) 1 0.00 ea 0.00
Warranty repair of Res Q Tee
Q-1 cutter(ser#033276)
Broken blade pin assy
Thank You For Your Business!! Subtotal $32.18
Terms&Conditions:All Sums Not Paid Within 30 Days Shall Bear Interest at 1.5%Per
Month Until Paid.
Sales Tax (0.0%) $0.00
www.midamericafire.com Total
$32.18
>rescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
%n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
nrhom, 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))
12844 L41 $32.18
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. WARRANT NO.
ALLOWED 20
Mid-America Fire & Safety LLC
IN SUM OF $
4001 N. St. Joseph Street
Evansville, IN 47720
$32.18
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT
Board Members
1120 I 12844 I 42-370.00 I $32.18 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 0 2012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund