186386 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB- DIETZ, INC CHECK AMOUNT: $1,491.80
CARMEL, INDIANA 46032 2708 E MICHIGAN ST
INDIANAPOLIS IN 46201 CHECK NUMBER: 186386
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239099 50440 34.30 OTHER MISCELLANOUS
651 5023990 S12013 7913 670.50 EXTINGUISHER PARTS AN
1120 4350900 7914 787.00 OTHER CONT SERVICES
k
JACOB I IETZ, INC.
Invoic
FIRE PROTECTION SPEC I A L I S T S
2708 East Michigan Street Date Invoice
Indianapolis, IN 46201
317- 631 -2304 Fax 317- 631 -3117 10127/2009 50440
Sill To: Ship To:
Carmel Police Department Carmel Police Department
3 Civic Square 3 Civic Square
Carmel, IN 46032 Carmel, 1N 46032
P.O. No. Work Order Terms Due Date Rep Project
10!27/2009 Carmel Police Depar...
Quantity Description Rate Amount
2 54 ABC recharge 15.50 31.00
2 OR27 Neck o -ring 1.15 2.30
2 Pull Pin 0.50 1.00
Payment is Due
........,.,,,eh
?AMERIUW n V 1 `I
E7�RE55`
Yellow is JDl copy please sign. oUev—
Subtotal $34.30
White is delivery copy for Customer.
Pi�� prey
Sales Tax (0.0 $0.00
TOM $34.30
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
Jacob— Dietz, Inc. Purchase Order No.
2708 East Michigan Street Terms
Indianapolis, IN 46201 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/27/09 50440 payment for fire extinguisher services 34.30
Total
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 -1.5.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jacob Dietz, Inc IN SUM OF
2708 East Michigan Street
Indianapolis, IN 46201
34.30
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
o a INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 50440 390 -99 34.30 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
June 3 20 10
-4aA A
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
JDJACOB-DETZ, INC. Invoice
FIRE PROTECTION SPECIALISTS
2708 East Michigan Street Date Invoice
Indianapolis, IN 46201
317 -631 -2304 Fax 317- 631 -311.7 5/21/2010 7914
Bill To: Ship To:
City of Carmel Fire Department
One Civic Square
Carmel, IN 46032
P.O. No. Work Order Terms Due Date Rep Project
5/25/2010
Quantity Description Rate Amount
1 Semi annual inspection of kitchen hood fire system for station 41 .80.00 80.00
2 Fusible links 5.00 10.00
1 Semi annual inspection of kitchen hood fire system for station 45 80.00 80.00
2 Fusible links 5.00 10.00
1 Semi -annual inspection of kitchen hood fire system for station 46 80.00 80.00
3 Fusible links 5.00 15.00
1 Semi- annual inspection of kitchen hood fire system for station 42 80.00 80.00
3 Fusible links 5.00 15.00
1 Hydrotest, recharge, regulator test of cylinder for Station 441 385.00 385.00
1 Hose assembly 32.00 32.00
Subtotal $787.00
Sales Tax (0.0 $0
Total- 787.00
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jacob Dietz
IN SUM OF
2708.Fast Michigan Street
Indianapolis, IN 46201
$787.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1120 7914 43- 509.00 $787.00 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
jUN 2010
3�
e
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
7914 $787.00
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
h
J DJACOB-nETZ, INC. Invoice
FIRE PROTECTION SPECIALISTS
2708 East Michigan Street Date Invoice
Indianapolis, IN 46201
317 -631 -2304 Fax 317- 631 -3117 5/21/2010 7913
Bill To: Ship To:
Carmel Utilities City of Carmel HHW
760 3rd Avenue SW 901 Rangeline Road
Carmel, IN 46032 Carmel, IN 46032
P.O. No. Work Order Terms Due Date Rep Project
5/21/2010 Carmel Utilities
Quantity Description Rate Amount
1 Semi annual inspection of dry chemical Fire Protection system for HH`vV 90.00 90.00
trailer
2 Quick Response Fusible Link 212 degree 8.50 17.00
1 IND 21 ABC cylinder 495.00 495.00
1 Cylinder actuator 68.50 68.50
Subtotal $670.50
Sales Tax (0.0 $0.00
Total $670.50
.,VOUCHER 10556.1 WARRANT ALLOWED
351351 IN SUM OF
JACOB- DIETZ, INC.
2708 E. Michigan St
Indianapolis, IN 46201
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
7913 01- 720H -08 $580.50
7913 01- 736H -08 $90.00
Voucher Total $670.50
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
I
T
An invoice or bill to be properly itemized must show, kind of service, where I
performed, dates of service rendered, by whom, rates per day, number of units,
i
price per unit, etc.
Payee
351351
JACOB- DIETZ, INC. Purchase Order No.
2708 E. Michigan St Terms
Indianapolis, IN 46201 Due Date 6/1/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/11/2010 7913 $670.50
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
Date Officer