213427 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 079150 Page 1 of 1
ONE CIVIC SQUARE DONLEY SAFETY
CARMEL, INDIANA 46032 5546 ELMWOOD AVE CHECK AMOUNT: $2,963.77
INDIANAPOLIS IN 46203 CHECK NUMBER: 213427
CHECK DATE: 1019/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 35322-A 2, 084 . 00 AUTO REPAIR & MAINTEN
1120 4351000 W2640 879 . 77 AUTO REPAIR & MAINTEN
110WInvoice
Please visit us on the web at wmv.donleysalety.com
Phone 317.786.2268 Date Invoice#
5546 Elmwood Ct. Fax 317-786-2532
Indianapolis, IN 46203
10/1/2012 35322--
Bill To Service Info
CARMEL,CITY OF CARMEL,CITY OF
ONE CIVIC SQUARE 2 CIVIC SQUARE
CARMEL,IN 46032 CARMEL,IN 46032
S.0. No. Terms Rep Vehicle Mileage VIN Customer P.O.
NET 30 H
Item Quantity Description Rate UOM Amount
AMBULANCE I Changes to new ambulances during building 2.084.00 2,084.00
process.
VIN IFDUF4GT9CEC39654
IN 1 FDUF4GTOCEC39655
Sales Tax (7.0%) $0.00
PRICE DISCREPANCIES,RETURN REQUESTS OR
SHIPMENT ERRORS MUST BE REPORTED WITHIN Total $2.084.00
30 DAYS TO RECEIVE CREDIT. If you have questions
about this invoice.Please call Debra O'Dair n
317-786-2268 or email to dodair ci donleysafety.com
DOALEY I acv®ice
MWPlease visit us on the web at www donleysafety,com
Phone 317-7e5-nse Date Invoice#
5546 Elmwood Ct. Fax 317-786-2532
Indianapolis,IN 46203
9/27/2012 W2640
Bill To Service Info
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE 2 CIVIC SQUARE
CARMEL,IN 46032 CARMEL, IN.46032
S.O. No. Terms Rep Vehicle Mileage VIN Customer P.O.
DUE ON RECEIPT FS AMB-45 131450 3HTMNAALX3N585816
Item Quantity Description Rate UOM Amount
REPAIR PARTS 1 INTERNATIONAL 109 B VALVE PN 134.99 134.99
3542905CI
REPAIR PARTS 1 INTERNATIONAL 104F VALVE 135.85 135.85
PN16897851-91
LABOR 5 TROUBLE SHOOT AIR RIDE SYSTEM AND 85.00 LABOR HRS 425.00
-DISCOVERED THAT CUSTOMER
INSTALLED WRONG VALVES IN SYSTEM,
REMOVED VALVES AND PURCHASED
INTERNATIONAL VALVES T14AT FIXED
THE PROBLEM
02840860 1 RH OFFSET ROTARY LATCH 18.69 EA 18.69
LABOR 1.2 REPLACED ROTARY LATCH STREET SIDE 85.00 LABOR HRS 102.00
REAR COMPARTMENT AND ADJUSTED
NADOR PIN
SHOP MISC. SHOP SUPPLIES,CLEANING 63.24 63.24
SUPPLIES,ETC.
Sales Tax (7.0%) $0.00
PRICE DISCREPANCIES,RETURN REQUESTS OR Total i $879.77
SHIPMENT ERRORS MUST BE REPORTED WITHIN
30 DAYS TO RECEIVE CREDIT. If you have questions
about this invoice,Please call Debra O'Dair @
317-786-2268 or email to dodair @donleysafety.com
Drescribed 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))
35322-A $2,084.00
W2640 A45 $879.77
I 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
Donley Safety
IN SUM OF $
5546 Elmwood Court
Indianapolis, IN 46203
$2,963.77
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
1120 35322-A 43-510.00 j $2,084.00 1 hereby certify that the attached invoice(s), or
1120 W2640 43-510.00 $879.77 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
OCT ®82012
y a
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund