315120 8/22/2017 (9)
CITY OF CARMEL, INDIANA VENDOR: 154252ONE CIVIC SQUARE INDIANA OXYGEN CO
CHECK AMOUNT: S*******236.33CARMEL, INDIANA 46032 PO BOX 78588 CHECK NUMBER: 315120
INDIANAPOLIS IN 46278 CHECK DATE: 08/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1094 4239012 1636964 236.33 SAFETY SUPPLIES
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
154252 Indiana Oxygen Company Terms
P.O. Box 78588
Indianapolis, IN 46278-0588
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/4/17 1636964 Oxygen Tank Refills xx5729 $ 236.33
Total $ 236.33
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
, 20
Clerk-Treasurer
ITEM SHIPQfy TY DESCRIPTION UOM PRICE AMOUNT
** Location: A ** i
- --- - ----- - - - UNIT
! OX AD 6 0 6: 0 OXYGEN, COMPRESSED 2.2 CYL 32.701 196.20
UN1072 (USP GRADE)
90CF @ 218.0000/100CF
VENTER LOT NUMBER ABOVE
Lot: C0726702 QLy: 2 Lot: D0726702 Qty:'i 4
FSCFUEL SURCHRG 1 OI ( DIESEL SURCHARGE OUR TRUCK EA 3.201 3.20
HMCHAZ MAT CHG lI 0' ' HAZARDOUS MATERIAL CHARGE , EA 5.95 5.95
Subtotal 205.35
40TAL CYLINDERS SHIPPED: 6 RETURNED: 0
Visit us qn facebook' or on the Delivery Charge I 30.98
web at ww .indianaoxygen.com
Taxable amount:, 0.00 ' I
CARMEL CLAY PARKS CUSTOMER: 03390 • • 236.33
1411 E. 116TH ST. INVOICE: 01636964 ,
CARMEL IN 46032 INVOICEDATE: 08/04/17
ORDER: 02515414-00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588