243981 04/08/2015 CITY OF CARMEL, INDIANA VENDOR: 154252
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $********93.31*
CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 243981
a„�oN INDIANAPOLIS IN 46278 CHECK DATE: 04/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 01263937 93.31 BOTTLED GAS
ITEM QrY can DESCRIPTION UOM PRIG AMOUNT.
,SHIP_'0_ -1 . .. —
** Location **
AC 75/25 1 0 1 1 ARGON,CARBON DIOXIDE 75/25 384CF CYL 84.285 84.29
INDUSTRIAL GAS MIX CGA580
384CF @ 21.9492/100CF
FSCFUEL SRCHGWC 1 0 DIESEL SURCHARGE W/C EA 3.07 3.07
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 5.95 5.95
Subtotal 93.31
=AL =INDERS SHIPPED: 1 RETURNED: 1
Visit us at fac book or oi the
web at www.indi maox.rgen. 2om
Taxable amount:l 10.00
CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT 93 .31
3400 W 131ST ST INVOICE: 01263937 INVOICETHIS
INCLUDING
CARMEL IN 46074 INVOICE DATE: 03/24/15
ORDER: 02117066-00 P/O: SHOP
INDIANA OXYGEN COMPANY • P.O. BOX 78588 9 INDIANAPOLIS, IN 46278-0588
VOUCHER NO. WARRANT NO.
Indiana Oxygen ALLOWED 20
IN SUM OF$
P. O. Box 78588
Indianapolis, IN 46278-0588
$93.31
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 01263937 j 42-311.00 $93.31 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
t
uISiApril 02, 2015
Stfo(�qps;lsigner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
a
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY QF 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))
03/24/15 01263937 $93.31
I
I
I
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