221631 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 357414 Page 1 of 1
4 � ONE CIVIC SQUARE NIGHTINGALE-ALAN MEDICAL,INC
CARMEL, INDIANA 46032 11418 DEERFIELD ROAD CHECK AMOUNT: $899.83
CINCINNATI OH 45242 CHECK NUMBER: 221631
CHECK DATE: 712/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 106672 899 . 83 SPECIAL DEPT SUPPLIES
Invoice-.� ' 106672
Nightingale-Alan Medical Equipment Services, LL( Date, >,. , 6/20/2013
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 CARMEL IN 46032
,q.
Purchase`Order No: Ciisto'meOD Sales ers61:ID . ` Shi in""Method, Ra ment.Terms,:,,, Re Shi Date
MARK HULETT CAR04 05 Net 30 6/20!2013
Ordered Shi e&,. B/O>u<` °.item Number :De§cri tion Discount`'. Un'it'Pricek:;' Ezt"Price
10.00000 10.00000 0.00000 ADC12-0242-000 RESQPOD ITD 10 $0.00000 $89.00000' $890.00
FOR WIRE TRANSFER PAYMENTS: There will be a 20% Subtotals w."': $8so.00
ACCT NAME: NIGHTINGALE ALAN MES LLC Misc' ,', _' $0.00
ACCT NUMBER:0073035204 restocking fee �"" $0.00
FIFTH THIRD BANK-ABA#042000314 on all returns unless Frei ht,, ". $9.83
PLEASE INCLUDE INVOICE AND CUSTOMER NUMBERS waived by management .Tr'ade.Discount $0.00
EXAMPLE.999991ABC01 TotaP $899.83
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))
106672 $899.83
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.
Nigtingale-Alan Medical Equipment Services, L ALLOWED 20
IN SUM OF $
11418 Deerfield Road
Cincinnati, OH 45242
$899.83
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 I 106672 1 102-390.11 I $899.83 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
JUL m l
(OrA-91"Pv'
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund