219383 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 354916 Page 1 of 1
€ ONE CIVIC SQUARE K&R MEDICAL REPAIR CHECK AMOUNT: $1,800.00
CARMEL, INDIANA 46032 3490 W SMITH VALLEY ROAD
o� GREENWOOD IN 46142 CHECK NUMBER: 219383
CHECK DATE: 4/24/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1201 R4341980 26421 26721 1, 800 . 00 WELLNESS PROGRAM
3490 W, SMIth Valley Road
Greenwood, IN 46142
Equipment Repair Inc Phone: (317) 865-4000
MWV\Vl-V\//�WWV—=—WWE1NV Fax: (317) 865-4001
www,kandrmedical,corn
CASH CITY OF CARMEL
ONE CIVIC SQUARE
CARMEL IN 46032
VIA
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A service charge of 11/2%Will be applied to any post due
balance.We also accept payments by Visa,MasterCard MAL $1,800,00
or Discover.30%regocking fee o n9&L2Urqh(3 4�6
and qguipMot. _glI retuF *es
Thank Van tap Vaulp Rualanuall
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))
04/19/13 26721 $1,800.00
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
K & R Medical Equipment Repair Inc
IN SUM OF $
3490 W. Smith Valley Road
Greenwood, IN 46142
$1,800.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel HR Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26421 I 26721 I 43-419.80 I $1,800.00 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
Monday, April 22, 2013
Director, HR
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund