305588 11/28/16 �f C�q�
Y" ';� CITY OF CARMEL, INDIANA VENDOR: 154252
' ONE CIVIC SQUARE INDIANA OXYGEN CO
CHECK AMOUNT: $*******363.35*
=q CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 305588
+.y�iTON,.�� INDIANAPOLIS IN 46278 CHECK DATE: 11/28/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 01517066 349.43 BOTTLED GAS
651 5023990 08415956 13.92 OTHER EXPENSES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
INDIANA OXYGEN CO ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
PO BOX 78588 IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
INDIANAPOLIS, IN 46278 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$349.43 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
01517066 42-311.00 $349.43 1 hereby certify that the attached invoice(s),or 11/15/16 01517066 $349.43
2201 201 2201 201
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
Friday, November 18,2016
Dave Huffman
Director
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
VOUCHER # 166551 WARRANT # ALLOWED
154252 IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
08415956 01-7362-06 13.92
Voucher Total 13.92
Cost distribution ledger classification if
claim paid under vehicle highway fund
ITEM SHHIPD' e/o DESCRIPTION UOM PRICE AMOUNT
** Location: D **
OX 220 1 0 1 1 UN1072,OXYGEN,COMPRESSED,2.2 CYL . 29.191 29.19
220CF CYLINDER
220CF @ 13.2686/100CF
AL S 1 0 1 1 ACETYLENE, DISSOLVED, 2.1 CYL 84.556 84.56
UN1001
147CF e 57.5211/100CF
RECORD "ACTUAL" CUBIC FOOTAGE
CF
CF
(60-175CF/CYL)
ALY1382F05 88 0 86 .035X44#$ SP SPOOLARC86 LB 2.46 216.48
86035X44 70S603SX44 SPOOL
TIL1464M 1 0 MD DP GRAIN DRVS GLV-CD PR 10.75 10.75
FSCFUEL SRCHGWC 1 0 DIESEL SURCHARGE W/C EA 2.50 2.50
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 5.95 5.95
Subtotal 349.43
OTAL IYLINDERS SHIPPED: 2 RETURNED: 2
Visit us at fac book oro the
web at wwv .indiinaox gen. om
Taxable amount: 0.00
CARMEL STREET DEPT CUSTOMER: 07851 • 349.43
•
3400 W 131ST ST INVOICE: 01517066
CARMEL IN 46074 INVOICEDATE: 11/15/16
ORDER: 02394323-00 P/O: SHOP
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
' INV ITEM INVOICE DATE INVOICE . `BEGINNING 'SHIPPED' RETURNED "ENDING- LEASED "`BAUDAYS' "CYLINDER 'EXTENDED
TYPE ., _ ., ...BALANCE ._ BALANCE. CYLINDERS'' -- RATE.. AMOUNT
ARG ARGON 1 0 0 1 0 31 .409 12.68
R CMF ASSET MANAGEMENr FEE 1.24 1.24
TAX: .00
CARMEL CITY OF CUSTOMER: 2066813.92
TOTAL
9609 HAZELDELL ROAD INVOICE: 08415956
INDPLS IN 46280 INVOICEDATE: 10/31/16
TOTAL CYL VALUE: 300.00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588