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CITY OF CARMEL, INDIANA VENDOR: 154252
CHECK AMOUNT: $******"*34.97ONE CIVIC SQUARE INDIANA OXYGEN COCARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 235422
INDIANAPOLIS IN 46278 CHECK DATE: 07/30/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01161965 34.97 OTHER EXPENSES
DESCRIPTION UOM UNIT' `AMOUNT
SHIP'D 1310 PRICE
** Location: A **
CD 50RB 1 0 1 1 CARBON DIOXIDE, 2.2 CYL 15.00 15.00
UN1013 (LIQUID WITHDRAW)
50CF @ 30.0000/100CF
FSCFUEL SRCHGWC 1 0 TEMP DIESEL SURCHARGE W/C EA 4.18 4.18
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 5.95 5.95
OKIMKL96101 12 0 ART PENCIL SILVER (12 BOX) EA 0.82 9.84
SILVERPENCIL
Subtotal 34.97
0TAL =INDERS SHIPPED: 1 RETURNED: 1
Visit us on fac book or on the
web at wm indi naox gen. om
Taxable amount: 0.00
CARMEL WATER CUSTOMER: 12598 • 34.97
•
3450 W 131ST ST INVOICE: 01161965
CARMEL IN 46074-8267 INVOICEDATE: 07/03/14
ORDER: 0199.7853-00 P/O:
:;A OXYGEN CO? A.N-Y . P.0; :ROX 78588-0 ANDIA . OLIS SIN. x. .46278-0588
VOUCHER # 141212 WARRANT# ALLOWED
154252 IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
01161965 01-6200-06 $34.97
I
Voucher Total $34.97
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
154252
INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 Due Date 7/22/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/22/2014 01161965 $34.97
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
7//->/� C'—"' V'—
Date Officer