221713 07/02/2013 CITY OF CARMEL, INDIANA VENDOR: 360209 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $1,647.99
CARMEL, INDIANA 46032 ATTN J ZIMMERMAN,ACCT REPTNG
10330 N MERIDIAN ST SUITE 430 CHECK NUMBER: 221713
INDIANAPOLIS IN 46290
CHECK DATE: 7/2/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 13192 1, 647 . 99 SPECIAL DEPT SUPPLIES
St. Vincent Hospital & Healthcare Center, Inc. Invoice
Attn:Jeremy Zimmerman
10330 N. Meridian,Suite 430 DATE INVOICE#
Indianapolis,IN.46290-1024
6/17/2013 13192
BILL TO
Carmel Fire EMS
Attn: Accounts Payable
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased May 2013 billed June 2013 1,647.99
Medical Supplies: $618.25
Transfer - Drugs: 1029.74
TOTAL: $1,647.99
See Attached
Any questions regarding the above charges can be directed to:
Pete Dillman, Program Director Emergency Medical Services
Phone: 317-338-7272
1-8766-1464. Please notate invoice number that you Total $1647.99
are paying on check/stub. Thank you!! '
Inquiries:Jeremy Zimmerman Payments/Credits $0.00
317.583.3223
jrzimmer @stvincent.org Balance Due $19647.99
I
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))
13192 $1,647.99
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
St. Vincent Hospital
Attn: Jeremy Zimmerman, Acct. Reporting IN SUM OF $
10330 N. Meridian Street, Ste. 430 N
Indianapolis, IN 46290
$1,647.99
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 I 13192 1 102-390.11 I $1,647.99 I 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 . 12013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund