188397 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
.•�i ONE CIVIC SQUARE JACOB- DIETZ, INC
0 CHECK AMOUNT: $286.30
o CARMEL, INDIANA 46032 2708 E MICHIGAN ST
INDIANAPOLIS IN 46201 CHECK NUMBER: 188397
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 W09326 51776 286.30 FIRE EXT INSPECTION
INC. J
PROTECTION SPECIALISTS
2708 East Michigan Street Date Invoice
Indianapolis, IN 46203
317 631 -2304 Fax 317- 631 -3117 6/30/2010 51776
Bill To: Ship To:
Water Distribution Water Distribution
760 3rd Avenue SW p 760 3rd Avenue SW
Carmel, IN 46032 ''2� V�' Carmel, IN 46032
P.O. No. Work Order Terms Due Date Rep Project
23500 6/30/2010 Water Distribution
Quantity Description Rate Amount
44 Fire Extinguisher annual inspection 100 132.00
2 10# ABC 6 year maintenance 13.00 26.00
1 10# ABC recharge 25.50 25.50
3 5# ABC 6 year maintenance 10.00 30.00
1 2 -1/2# ABC 6 year maintenance 7.25 7.25
7 OR27 Neck o -ring 1.30 9.10
6 Badger stem 6.00 36.00
1 Amerex stem 6.00 6.00
1 195 PSI dry chemical gauge 4.50 4.50
1 Pull Pin 0.75 0.75
6 Hazardous Material Communication Label 0.70 4.20
1 Truck charge 5.00 5.00
Subtotal $286.30
Sales Tax (0.0 $0.00
Total $286.30
VOUCHER 102250 WARRANT ALLOWED
3511351 IN SUM OF
JACOB- DIETZ, INC.
27Q8 E. Michigan St.
0�
Indianapolis, IN 46201
RAI
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
51776 01- 6360 -03 $143.15
51776 01- 6360 -06 $143.15
Voucher Total $286.30
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
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
351351
.JACOB- DIETZ, INC. Purchase Order No.
2708 E. Michigan St, Terms
Indianapolis, IN 46201 Due Date 7/27/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/27/2010 51776 $286.30
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