193134 12/22/2010 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $116.08
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278
'tips: s CHECK NUMBER: 193134
CHECK DATE: 12/22/2010
DEPA ACCOUNT P O NUMBER INVOICE NUMB AMOUNT DESCRIPTION
2201 4231100 00679203 97.20 BOTTLED GAS
2201 4231100 01394019 -00 18.88 BOTTLED GAS
ORIGINAL INVOICE
INDIANA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 00679927 ORDER: 01394019-00
INDIANAPOLIS, IN 46278 -0588 INVDATE: 12/10/10 ORD DATE: 12/08/10
317- 290 -0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 INT: TRM
P /O: 12 -8 -2010
TERMS: NET 30
SHIP VIA: UPS
RELEASE GARY
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
3400 W 131ST ST P 3400 W 131ST ST
CARMEL IN 46074 CARMEL IN 46074
T T
O O
INVOICE AMOUNT: 18.88
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
ITEM oTY Q10 DESCRIPTION UOM UNIT
sHiP•a AMOUNT
E3 PRICE
RELEASE GARY
Location: A
TIL48XL 1 1 L LINED GOAT /SPLIT BACK MIG GLV PR 10.25 10.25
-CD
Subtotal 10.25
Dud to current fuel orices IOC Frei ht 8.63
has adjus ed the Fuel Surcharge
Taxable amount: 0.00
CARMEL STREET DEPT CUSTOMER: 07851 18.88
9
3400 W 131ST ST INVOICE: 00679927
CARMEL IN 46074 INVOICEDATE: 12/10/10
ORDER: 01394019 -00 P /O: 12 -8 -2010
INDIANA OXYGEN COMPANY P.O. BOX 78588 v INDIANAPOLIS, IN 46278 -0588
ORIGINAL INVOICE
INDIAN -A INDIANA O COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 00679203 ORDER: 01393964 -00
INDIANAPOLIS, IN 46278 -0588 INV DATE: 12/08/10 I ORD DATE: 12/08 10
317- 290 -0003 SALESPERSON: 000 LTERR: 007
BRANCH: 004 ENT: TRM
Pro: 12 -8 -2010
TERMS: NET 30
SHIP VIA: Will Call
RELEASE
B CARMEL STREET DEPT H CARMEL STREET DEPT
3400 W 131ST ST P 3400 W 131ST ST
CARMEL IN 46074 CARMEL IN 46074
T T
O O
INVOICE AMOUNT: 97.20
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
UNIT
ITEM S so DESCRIPTION -UOM PRICE. AMOUNT
Location: D
OX 220 1 0 1 1 OXYGEN, COMPRESSED, 2.2 CYL 22.00 22.00
UN1072
220CF 10.0000 /100CF
AL S 1 0 1 1 ACETYLENE, DISSOLVED, 2.1 CYL 47.996 48.00
UN1001
147CF 32.6503/1000F
RECORD "ACTUAL" CUBIC FOOTAGE
CF
CF
(60 -175CF /CYL)
TIL48L 2 0 LG LINED GOAT /SPLIT BACK MIG GLV PR 10.25 20.50
-CD
FSCFUEL SRCHGWC 1 0 TEMP DIESEL SURCHARGE W/C EA 3.'75 3.75
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
Subtotal 97.20
TOTAL YLTNDERS SHIPPED: 2 RETURNED: 2
Dua to current fuel price IOC
t
has adjus ed the Fuel Sur harge
Taxable amount: 0.00
CARMEL STREET DEPT CUSTOMER: 07851 O 97.20 THIS
3400 W 131ST ST INVOICE: 00679203 INCLU
CARMEL IN 46074 INVOICEDATE: 12/08/10
ORDER: 01393964 -00 P /O: 12 -8 -2010
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
VOUCHER NO. WARRANT N
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$116.08
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO #I Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
2201 01394019 -00 42- 311.00 $1888 1 hereby certify that the attached invoice(s), or
2201 00679203 42- 311.00 $9720 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
�Thursday,,Decernlier 16, 2010
Street Commissipnpr
Street C( t ��missioner
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))
12/08110 01394019 -00 $18.88
12/08/10 00679203 $97.20
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