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211786 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 131135 Page 1 of 1 ONE CIVIC SQUARE HOOSIER FIRE EQUIPMENT INC s CHECK AMOUNT: $16.00 ,,•�,?� CARMEL, INDIANA 46032 4009 MONTDALE PARK DRIVE VALPARAISOIN 46383 CHECK NUMBER: 211786 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4351000 81224 95 . 00 AUTO REPAIR & MAINTEN 1120 4351000 81230 —79 . 00 AUTO REPAIR & MAINTEN ****** INVOICE ****** PAGE: 1 Hoosier Fire Equipment, Inc. INVOICE NUMBER: 0081230-IN 4009 Montdale Park Drive INVOICE DATE: 08/02/12 Valparaiso, Indiana 46383 ORDER NUMBER: ORDER DATE: (219) 462-1707 SALESPERSON House/MS CUSTOMER NO: CARM01 SOLD TO: SHIP TO: Carmel Fire Department Carmel Fire Department 2 Civic Square 2 Civic Square Carmel IN 46032-7543 Carmel IN 46032-7543 CONFIRM TO: -------------------------------------------------------------------------------- CUSTOMER P. O. SHIP VIA F. O. B TERMS OUR DELIVERY Net 10 -------------------------------------------------------------------------------- ITEM NO. UNIT ORDERED SHIPPED BACK ORD PRICE AMOUNT -------------------------------------------------------------------------------- QL48Z15C EACH 4 . 00 4 . 00 0 . 00 39 . 50 158 . 00 SOUTH PARK 1-112" QUIC-LOC HOLDER QL48Z25C EACH 6 . 00 6 . 00 0 . 00 39 . 50 237 . 00 SOUTH PARK 2-1/2" QUIC-LOC HOLDER HSMB-50 EACH 6. 00 6. 00 0 . 00 56. 00 336 . 00 HARRINGTON 5" STORZ MOUNTING BRACKET /SORDER EACH 1 . 00 1 . 00 0 . 00 810 . 00- 810 . 00- CREDIT FOR LOOSE EQUIPMENT INSTALLATION ON NEW SEAGRAVE MII PUMPERS (#78G45-46) TAXABLE . 00 NON-TAXABLE 79. 00- NET INVOICE: 79 . 00- SALES TAX: . 00 FREIGHT : . 00 INVOICE TOTAL: 79 . 00- ****** INVOICE ****** PAGE: 1 Hoosier Fire Equipment, Inc. INVOICE NUMBER: 0081224-IN 4009 Montdale Park Drive INVOICE DATE : 08/02/12 Valparaiso, Indiana 46383 ORDER NUMBER: ORDER DATE: (219) 462-1707 SALESPERSON House CUSTOMER NO: CARM01 SOLD TO: SHIP TO: Carmel Fire Department Carmel Fire Department 2 Civic Square 2 Civic Square Carmel IN 46032-7543 Carmel IN 46032-7543 CONFIRM TO: -------------------------------------------------------------------------------- CUSTOMER P. O. SHIP VIA F. O. B TERMS OUR DELIVERY Net 10 -------------------------------------------------------------------------------- ITEM NO. UNIT ORDERED SHIPPED BACK ORD PRICE AMOUNT -------------------------------------------------------------------------------- /SERVICE EACH 1 . 00 1 . 00 0 . 00 95 . 00 95 . 00 REPAIRS ON CUSTOMER' S 1996 KME PUMPER, SERIAL #2670, ENGINE #49 - AS PER ATTACHED TAXABLE . 00 NON-TAXABLE 95 . 00 NET INVOICE: 95 . 00 SALES TAX: . 00 FREIGHT: . 00 INVOICE TOTAL: 95 . 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 invoice(s) or bill(s)) 81224 E40 $95.00 81230 ($79.00) 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 VOUCHER NO. WARRANT NO. ALLOWED 20 Hoosier Fire Equipment IN SUM OF $ 4009 Montdale Park Drive Valparaiso, IN 46383 $16.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 81224 43-510.00 $95.00 1 hereby certify that the attached invoice(s), or 1120 81230 43-510.00 ($79.00) 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 AUG 13 2012 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund