251130 11/04/15 ,CAA.
'" CITY OF CARMEL, INDIANA VENDOR: 154252
® it ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $ '""*'192.48"
:. ?� CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 251130
''''�.aN�"� INDIANAPOLIS IN 46278 CHECK DATE: 11/04/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 01349517 192.48 BOTTLED GAS
ORIGINAL INVOICE
INDIANA INDIANA OXYGEN COMPANY CUSTOMER: 07851 ' PAGE: 1
OXYGEN P.O.BOX 78588 INVOICE: 01349517 J ORDER: 02215201-00
INDIANAPOLIS,IN 46278-0588 INV DATE: 10/20/15 ORD DATE: 10/20/15
317-290-0003 SALESPERSON: 000 I TERR: 007
BRANCH: 004 INT: JRB
P/O: SIGNS
TERMS: NET 30
SHIP VIA: Will Call
RELEASE#:
B S
CARMEL STREET DEPT H CARMEL STREET DEPT
�
3400 w 131ST ST P 3400 w 131ST ST
CARMEL IN 46074 CARMEL IN 46074
T T
O O
INVOICE AMOUNT: 192.48
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
Cry ..—QTy - rc �Tvini - _ - UCM _UNIT AMOUNT,
- -" - -ITCIV�. .. ...� I SHIF'D„ "B/0. - —DESCRI iwiv- -�.
PRICE
** Location: D **
AR 336 1 0 1 1 UN1006, ARGON, COMPRESSED, 2.2 CYL 81.585 81.59
336CF @ 24.2813/1000F
TIL1464M 1 0 MD DP GRAIN DRVS GLV-CD PR 9.99 9.99
WLT13N24 1 0 1/8" COLLET PK 7.00 7.00
WT9/ WT20/ WT25/
WLT13N29 1 0 1/8" COLLET BODY PKG 13.50 13.50
WT9/ WT20/ WT25/
INW187G 1 0 1/8X7 GRD PURE GREEN PK 67.80 67.80
TUNGSTEN 187G
IOKICEP932-442 5 0 4.5 X 5.25 CLEAR POLYCARB SAFETY EA 0.80 4.00
PLATE 4X5CLPL COVERPLATE
FSCFUEL SRCHGWC 1 0 DIESEL SURCHARGE W/C EA 2.65 2.65
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 5.95 5.95
Subtotal 192.48
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 1
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, Taxable amount:, 0.00
CARMEL STREET DEPT CUSTOMER: 07851 192.48
3400 W 131ST ST INVOICE: 01349517
CARMEL IN 46074 INVOICEDATE: 10/20/15
ORDER: 02215201-00 P/O: SIGNS
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))
10/20/15 01349517 $192.48
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Oxygen
IN SUM OF $
P. O. Box 78588
Indianapolis, IN 46278-0588
$192.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 I 01349517 I 42-311.001 $192.48 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
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Cost distribution ledger classification if
claim paid motor vehicle highway fund