250279 1 0/07/1 5 `' *f CITY OF CARMEL, INDIANA VENDOR: 154252
® ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $*******271.41
CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 250279
9,;`rOry � INDIANAPOLIS IN 46278 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
854 4359025 01334126 271.41 ARTS DISTRICT FESTIVA
ORIGINAL INVOICE
.NIJIAN-A INDIANA OXYGEN COMPANY CUSTOMER: 21366 PAGE: 1
\ P.O. BOX 78588 INVOICE: 01334126 ORDER: 02196781-00
INDIANAPOLIS, IN 46278-0588 INV DATE: 09/14/15 ORD DATE: 09/10/15
317-290-0003 SALESPERSON: 000 TERR: 005
BRANCH: 001 INT: BC
P/O:
TERMS: NET 30
SHIP VIA: Our Truck
RELEASE#:
B S
I CARMEL, CITY OF H CARMEL, CITY OF
� 1 CIVIC SQUARE P 111 W MAIN STREET
CARMEL IN 46032 CARMEL IN 46032
T T
O O
INVOICE AMOUNT: 271.41
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
- - - �_ _I INIT _ —
i i tivi 1 SHIP'D sio _ utSCrsir I IUN I iiQiJi` " . PRICE r�iwOulwi
** Location: A **
HE 200 1 0 1 0 HELIUM BALLOON GRADE 200CF CYL 232.277 232.28
CGA580—NOT FOR INDUSTRIAL USE
2000F @ 116.1385/100CF
RENB/F 1 0 BALLOON FILLER EA 3.00 3.00
******CALL 30MINS BEFORE ARRIVAL 317-496-9116 STEPHANIE MARSHALL************
I I
***** HAS AS AN EVENT ON SATURDAY HAS TO GO*****************
i
FSCFUEL SURCHRG 1 0 DIESEL SURCHARGE OUR TRUCK EA 3.20 3.20
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 5.95 5.95
Subtotal 244.43
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 0
-e-S ✓ is
Visit us on faclbook or oh the Delivery Charge 26.98
we at wvn indianaoxygen.� om
Taxable amount: 0.00
CARMEL, CITY OF CUSTOMER: 21366 • 271.41
1 CIVIC SQUARE INVOICE: 01334126 ,
CARMEL IN 46032 INVOICEDATE: 09/14/15
ORDER: 02196781-00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
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))
09/14/15 01334126 $271.41
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
Indiana Oxygen Company, Inc. ALLOWED 20
IN SUM OF $
P. O. Box 78588
Indianapolis, IN 46278
$271.41
ON ACCOUNT OF APPROPRIATION FOR
Community Relations Gift Fund 854
i°O#/Dept. INVOICE NO. ACCT#lrlTLE AMOUNT Board Members
854 I 01334126 I Arts District Festivals I $271.41 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
M7 y, October 05, 2015
Director, Community Relations/Economic evelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund