245884 06/03/15 (9,
CITY OF CARMEL, INDIANA VENDOR: 00351351
ONE CIVIC SQUARE JACOB-DIETZ, INC CHECK AMOUNT: $*******524.40*
CARMEL, INDIANA 46032 130 S EWING ST CHECK NUMBER: 245884
INDIANAPOLIS IN 46201 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 61080 104.40 OTHER CONT SERVICES
1120 4350100 9115 312.00 BUILDING REPAIRS & MA
651 5023990 9116 108.00 OTHER EXPENSES
J_DJACOB-DIETZ, INC. Invoice
,I R E PROTECT] ON S PEC IALISTS
130 South Ewing St. Date Invoice#
Indianapolis,IN 46201
317-631-2304 Fax 317-631-3117 5/20/2015 9116
Bill To: Ship To:
Carmel Utilities City of Cannel FH-1W
760 3rd Avenue SW 901 Rangeline Road
Cannel,IN 46032 Carmel, IN 46032
P.O.No. Work Order# Terms Due Date Rep Project
26055 5/20/2015 REG Carmel Utilities
Quantity Description Rate Amount
1 Semi-annual inspection of dry chemical Fire Protection system for 90.00 90.00
HHW trailer
2 Quick Response Fusible Link 212 degree 9.00 18.00
Subtotal $108.00
Sales Tax $0.00
If not paid by due date,late charges will be assessed at the rate of 1.5%per month. Total $108.00
VOUCHER # 155619 WARRANT # ALLOWED
351351 IN SUM OF $
JACOB-DIETZ, INC.
130 S. EWING STREET
Indianapolis, IN 46201
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9116 01-720H-08 $18.00
9116 01-736H-08 $90.00
Voucher Total $108.00
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
351351
JACOB-DIETZ, INC. Purchase Order No.
130 S. EWING STREET Terms
Indianapolis, IN 46201 Due Date 6/1/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/1/2015 9116 $108.00
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
Date -/Officer
JDJAC0B-Di=JNC* Invoice
FIRE P R O T E C T I O N S P E C I A L I S T S
130 South Ewing St. Date Invoice#
Indianapolis,IN 46201
317-631-2304 Fax 317-631-3117 4/15/2015 61080
Bill To: Ship To:
Carmel Fire Department Carmel Fire department
2 Civic Square One Civic Square
Carmel IN 46032 Carmel IN 46032
P.O.No. Work Order# Terms Due Date Rep Project
FF 32184 5/1/2015 JWR Carmel Fire Departm...
Quantity Description Rate Amount
1 20#ABC recharge 40.50 40.50
4 100 psi gauge(water) 7.50 30.00
1 OR29 Neck o-ring 1.30 1.30
1 Amerex stem 8.00 8.00
1 Hazardous Material Communication Label 0.70 0.70
1 UN1044 DOT Label 0.65 0.65
1 20#hose band 5.25 5.25
1 Truck charge 18.00 18.00
Subtotal $104.40
Sales Tax $0.00
If not paid by due date,late charges will be assessed at the rate of 1.5%per month. Total $104.40
JDJACOB-DETZ, INC. Invoice
F I R E P R O T E C T I O N S P E C I A L I S T S
130 South Ewing St. Date Invoice#
Indianapolis,IN 46201
317-631-2304 Fax 317-631-3117 5/20/2015 9115
Bill To: Ship To:
City of Carmel Fire Department
One Civic Square
Carmel,IN 46032
P.O.No. Work Order# Terms Due Date Rep Project
31294,31295,3 1296,31297 5/20/2015 REG
Quantity Description tion Rate Amount
1 Semi-annual inspection of kitchen hood fire system for station 41 58.00 58.00
2 Fusible links 8.00 16.00
1 Semi-annual inspection of kitchen hood fire system for station 45 58.00 58.00
2 Fusible links 8.00 16.00
1 Semi-annual inspection of kitchen hood fire system for station 46 58.00 58.00
3 Fusible links 8.00 24.00
1 Semi-annual inspection of kitchen hood fire system for station 42 58.00 58.00
3 Fusible links 8.00 24.00
Subtotal $312.00
Sales Tax $0.00
If not paid by due date,late charges will be assessed at the rate of 1.5%per month. Total $312.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jacob Dietz
IN SUM OF$
130 S. Ewing Street
Indianapolis, IN 46201
$416.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#IrITLE AMOUNT Board Members
1120 61080 43-509.00 $104.40 1 hereby certify that the attached invoice(s), or
1120 9115 43-501.00 $312.00 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
JUN - 1 2015
I
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor 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 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))
61080 $104.40
9115 $312.00
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