219838 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 357414 Page 1 of 1
0 ONE CIVIC SQUARE NIGHTINGALE-ALAN MEDICAL, INC CHECK AMOUNT: $1,256.29
CARMEL, INDIANA 46032 11418 DEERFIELD ROAD
o� CINCINNATI OH 45242 CHECK NUMBER: 219838
CHECK DATE: 517/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 106028 1, 256 .29 SPECIAL DEPT SUPPLIES
I'n'Voic6 '` 106028
Nightingale-Alan Medical Equipment Services, LL( Date '- r .: 4/22/2013
11418 Deerfield Road
Cincinnati OH 45242
(513)247-8200 1 (800) 332-3700 1 fax(513) 247-8207
Bill To: Ship To:
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE 2 CIVIC SQUARE
CARMEL IN 46032 ATTN: MARK HULETT
CARMEL IN 46032
Purchase.Order No.:`-' Customer ID�..:':." Sales erson ID Shi " in Method="' Pa ment'Terms Re "Date
— CAn04 1,V222013
Ordered Shi ' ed`:" B/0.- Item Number Descri tion Discount Unit Price'. Ext-Price
14.00000 14.00000 0.00000 ADC12-0242-000 RESQPOD ITD 10 $0.00000 $89.00000 $1,246.00
1.00000 1.00000 0.00000 ADC12-0242-000 RESQPOD ITD 10-NO CHARGE $0.00000 $0.00000 $0.00
1 1 0 MISC (1)AT NO CHARGE FOR BUYING(10)EA $0.00000 $0.00000 $0.00
FOR WIRE TRANSFER PAYMENTS: subtotal::= :.','p:' $1 246.00
There will be a 20% Msc " $0.00
ACCT NAME: NIGHTINGALE ALAN MES LLC restocking fee
ACCT NUMBER: 0073035204 $0.00
FIFTH THIRD BANK-ABA#042000314 on all returns unless Frei ht $10.29
PLEASE INCLUDE INVOICE AND CUSTOMER NUMBERS waived by management Trade.Discount. $0.00
EXAMPLE:999991ABCOI Tatal . " $1 256.29
VOUCHER NO. WARRANT NO.
ALLOWED 20
Nigtingale-Alan Medical Equipment Services, L
IN SUM OF $
11418 Deerfield Road
Cincinnati, OH 45242
$1,256.29
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 106028 1 102-390.11 I $1,256.29 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
MAY 6 21013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Irescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
Nn 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))
106028 $1,256.29
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