260212 06/28/16 (9, )
CITY OF CARMEL, INDIANA VENDOR: 154252
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECKAMOUNT: $********13.92*
CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 260212
INDIANAPOLIS IN 46278 CHECK DATE: 06/28/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 08394336 13.92 OTHER EXPENSES
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 6/10/2018
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/2016 08394336 $13.92
hereby certify that the attached invoice(s), or bill(s) is(are)true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer
CYLINDER RENTAL INVOICE
INDIANA INDIANA OXYGEN COMPANY CUSTOMER:2 0 6 6 8 PAGE: 1
P.O.BOX 78588 INVOICE: 08394336
INDIANAPOLIS,IN 46278-0588 INV DATE: 05/31/16
317-290-0003 SALESPERSON:0 0 0 TERR: 0 0 7
BRANCH: 004
P/O:
TERMS: NET 30
9 CARMEL CITY OF H CARMEL CITY OF
L 9609 HAZELDELL ROAD P 9609 HAZELDELL ROAD
INDPLS IN 46280 INDPLS IN 46280
T T
0 O
INVOICE AMOUNT: 13 .92
---------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
INV - .. ITEM INVOICE DATE INVOICE 7,.. 'BEGINNING SHIPPED RETURNED. ENDING '-LEASED BAUDAYSi-: CYLINDER !!.EXTENDED' i
TYPEBALANCE-' - _.. BALANCE CYLINDERS - RATE „ AMOUNT-
_ ..
R ARG ARGON 1 0 0 1 0 31 .409 12.68
R CMF ASSET MkNAGEMENr FEE 1.24 1.24
TAX: .00
CARMEL CITY OF CUSTOMER: 20668 TOTAL , 13.92
9609 HAZELDELL ROAD INVOICE: 08394336
INDPLS IN 46280 INVOICEDATE: 05/31/16
TOTAL CYL VALUE: 300.00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588 9 INDIANAPOLIS, IN • 46278-0588