213124 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366564 Page 1 of 1
` ONE CIVIC SQUARE OPTUMINSIGHT
CARMEL, INDIANA 46032 Po eox saoso CHECK AMOUNT: $135.90
CHICAGO IL 60680-1050 CHECK NUMBER: 213124
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4469000 80011022359 135 . 90 LIBRARY REF MATERIALS
Optum
' ®■ Y U• ■T M
PO BOX 88050
Chicago, IL 60680-1050
800/464-3649 Option 1
FAX 801/982-4033
Federal Tax ID# 41-1858498 °
°
Invoice # 80011022359
Customer # 1715996
2556473IIA0156001
Bill To: Carmel Fire Dept Ambulance Services
Accounts Payable Check your account or pay online at:
2 Civic Sq
Carmel , IN 46032-7543 www.optumcoding.com
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Ship To: Carmel Fire Dept Ambulance Services
Becky Lannan
2 Civic Sq
Carmel , IN 46032-7543
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09/10/2012 1 6701379 1 1 Net 15 Days
PurchaseOreler.Number _ flyderDate_�I nt-ATjrackiri NcimEer °' .-
09/10/2012 1 HK6
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or Sh d `If6iR .- `µ Des r ..tlon Un t .Price �.,Dbi(scount et, Amount
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1 1 0053 Standard Shipping (Total Order Charge) 10.95 .000% 10.95
ISBN: 1563374781
1 1 3539 ICD-9-CM Expert for Hospitals, Vol . 1 , 2 124.95 .0001/. 124.95
ISBN:9781601514943
100% Money Hack Guarantee
If our merchandise* ever fails to meet your expectations,
please contact our customer service department at the 800
listed on this invoice for an immediate response. Non-Taxable Subtotal 135.90
*Software: Credit will be granted for unopened packages only Taxable Subtotal .00
FOB Optuminsight warehouse. Title and risk of loss passes to Tax .00
buyer upon delivery to carrier. Invoice Total 135.90
IPayment/Credit .00 �
Total Due 135.90
MD5508.GRN(12512)
Please detach and remit with payment
Drescribed by State Board of Accounts City Form No.201 (Rev. 1995)
ACCOUNT; PAYABLE VOUCHER
CITY OF CARMEL
An invoicc Or b I H to ba propai'ly iiernized must;;I low: !-,Ind of service,wherc periori-ned, dates service rendered, by
whom, ralcs her da.y, 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))
80011022359 I I $135.90
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
Optum Insight
IN SUM OF $
PO Box 88050 ---------
__—_,--___—__.___.-- -_-----.___._____
Chicago, IL 60680-1050 — -
$135.90
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
T
1120 I 80011022359 1 102-690.00 I $135.90 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
SEP 2 4 2042
L.
" k
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund