312425 06/13/17 1+of C.�q*f
f;; �• CITY OF CARMEL, INDIANA VENDOR: 154252
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $***'*''*40.65'
,r°; CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 312425
' INDIANAPOLIS IN 46278 CHECK DATE: 06/13/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01598333 40.65 OTHER EXPENSES
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ITEM CE—
DESCRIPTION UOM AMOUNT
CD SORB 1 0 1 1! CARBON DIOXIDE, 2.2 CYL 32.15111 32.15
UN1013 (LIQUID WITHDRAW)
SOCF @ 64.3020/1000F
FSCFUEL SRCHGWC 1 Oii ( DIESEL SURCHARGE WIC EA 2.551 2.55
HMCHAZ MAT CHG 11, 1 OI HAZARDOUS MATERIAL CHARGE EA 5.951 5.95
Subto al 40.65
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OTAL CYLIN�ERS SHIPPED: 1 RETURNED: 1i
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( Taxable amount: _
CARMEL WATER 0 00
CUSTOMER: 12598 • • 40.65
3450 W 131ST ST INVOICE: 01598333
CARMEL IN 46074-8267 INVOICEDATE: 05/09/17
ORDER: 02476761-00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
INDIANA INDIANA OXYGEN COMPANY, INC.
P.O. BOX 78588 DELIVERY TICKET
WGEN.
INDIANAPOLIS, INDIANA 46278-0588
Bloomington Cincinnati Elkhart + Fishers + Fort Wayne + Indianapolis
■ (812)330-9210 (513)353-2448 (574)295-4433 (317)841-0002 (260)918-0241 (317)290-0003
j Lafayette + Marion + Muncie + Seymour + Vincennes
(765)474-7095 (765)662-8700 (765)289-2373 (812)522-4421 (812)882-4323
America's Oldest Gas/Welding Supply "'926966.566
CUSTOMER 12598
ORDER 02476761--00
CARMEL. WATER
3450 W 131ST STREET ORDER DATE 05/09/17
CARMEL. IN 46032 PAGE C.) )1 OF (__)O 1
317-733-2855
5
NAME CARMEL WATER TERR 007 SHIP VIA Will Call -NONE- INITIALS DAB
P.O.# SALES 440 SHIP CODE 00 UPS 0 ORDER TYPE CHRG
REL# BRANCH 001 COL/PPD PREPAID TIME 09-MAY-17 01:49PM
PHONE# 317-733-2855 SEL ROUTE# USERNAME dons
QTY UNIT HM -------DESCRIPTION------------ ID LINE ------ITEM----- LOC QTY -CYLINDERS- VOLUME/ UNIT EXTENDED
SHIP & HAZARD CLASS NUMBER NO NUMBER ORDER SHIP 1ETN WEIGHT MOUNT AMOIRIT
------------------------------------------------------------------------------------------------------------------------------------
1 CYL CARBON DIOXIDE, 2.2 1 CD 50R8 A 1 1 1 50 32.151 32.15
LN1013 (LIQUID WITHDRAW)
177.00
QTY UNIT HM --------DESCRIPTION----------- LINE ------ITEM------ LDC QTY QTY BIN DIGHT LNIT EXTENDED
.SHIP .$ HAZARD CLASS NO NICER ORDER BKORD LOC AMOUNT AMOUNT
—r W
1 EADIESEL SURCHARGE W/C 2 FSC FUEL SRCHGWC A 1 0 .00 2.55 2.55
1 EA HAZARDOUS MATERIAL CHARGE 3 HMC HAZ MAT CFI; A 1 0 .00 5.95 5.95
Total Weight: 177.0000 Subtotal 40.65
Tax .00
Freight .00
Total Sale 40.65
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DELIVERED MAY 19 209
SPECIAL INSTRUCTIONS: PLACARDS: ACCEPTED REFUSED
EMERGENCY RESPONSE TELEPHONE NUMBER: 8005355053
Customer authorizes Seller to debit Customer's credit card or deduct f o• the,,, TERMS&CONDITIONS
"� CUSTOMER HEREIN CONSENTS TO AND ACCEPTS THE ABOVE PRODUCTS
Customer's deposit an outstanding balance remaining on the Customer's ac �ry SECT TO ALL OF THE CONDITIONS AS SET FORTH ON REVERSE SIDE HEREOF
P y g g AND T E EXISTING CONTRACT BETWEEN BOTH PARTIES. f
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IMPORTANT DATE
PLEASE READ CAREFULLY THE TERMS AND CONDITIONS OF SALE WHICH APPEAR RECEIVED S N TURE)
ON THE REVERSE SIDE OF THIS DOCUMENT. ALL SALES MADE ARE SUBJECT TO
j SUCH TERMS AND CONDITIONS. CUSTOMER SIGNATURE HEREON VERIFIES X
SHIPPED AND RETURNED RENTAL CYLINDER COUNT. SHIPPED BY
CUSTOMER