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Home My WebLink About198428 06/22/2011 CITY OF CARMEL, INDIANA VENDOR: 359344 Page 1 of 1 ONE CIVIC SQUARE AYERS BACKFLOW CHECK SERVICE CHECK AMOUNT: $150.00 CARMEL, INDIANA 46032 20 BENNETT ROAD CARMEL IN 46032 CHECK NUMBER: 198428 CHECK DATE: 6/22/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1093 4350100 213580 150.00 BUILDING REPAIRS MA 213500 INVOICE SOLD TO: SHIPPED TO: G mac. GAL G£ti� -L ADDRESS ADDRESS 20 Bennett Rd. S 6 J,,VT7�4Z �ii'964 2 (,v CITY, STATE, ZIP c,9� CITY, STATE, ZIP C armel, 46032 yGo3Z- CUSTOMER'S ORDER SALESPERSON TERMS VIA F.O.B. J TE j/}e,��U �2 w2 2 30:00 q 067 2 ii 3v p� J oo36y3 I Z 30 do w Z 69'006' Z I2-1411 3� Purchase Description P.O. P or F r_ Budget Line Descr Purchaser Date -Approval Bat Ad V &,ad.w 8140 s BACKFLOW PREVENTION TEST ADDRESS CI'T'Y ZIP BUS�RESIDENCE TELEPHONE S.- C. i s MAKE MODEL SERIAL SIZE f LOCATION --�•�y NEXT TEST- DATE BY-,. REDUCED PRESSURE ASSEMBLY DOUBLE CHECK VALVE (D� PVB CHECK.VALVE #1. CHECK_ VALVE #2 RELIEF VALVE. PVB1SVB, .S�t Imo, DCDA TEST Held at 4? a L, PSID Held at PSID Opened AIR INLET RPDA at PSID Opened AG at PSID AVB Closed a st tight Did Not Did Not Leaked Leake ODen CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not A IWN Leaked Open CLEANED AIR GAP REPLACED Pipe Size Dist. FINAL aJ1a? s PSID PSID„ ;Opened Air Inlet TEST Closed at PSID PSID I tight Gheck Valve PSID INITIAL TEST BY. TESTER f N' 3 "I95 0896' I( R: DATE: 4-- 2 Phone: (317) 258 6118 Fax: (317) -66 0087 TIME `Y��"`' COMMENTS: C f Ayers Backflow; Check Service 20 BENNETT ROAD CARMEL, INDIANA 46032 BACEYLOW PREVENTION TEST ADDRESS CITY ZIP BUSINES ARESIDENCE TELEPHONE MAKE MODEL SERIAL SIZE LOCATION NEXT TEST DATE BY REDUCED PRESSURE ASSEMBLY x y� 0- DOUBLE CHECK VALVE DO PVB CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB /SVB SVB INITIAL o DCDA TEST Held at S r PSID Held at PSID Opened AIR INLET RPDA at -2. Z- PSID Opened AG at PSID AVB Closed tight Did Not Did Not Leaked Leake Qpg>rl CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not Leaked Open CLEANED AIR GAP REPLACED Pipe Size Dist. FINAL PSID PSID Opened Air Inlet TEST Closed at PSID PSID tight_ Check Valve PSID INITIAL TEST BY nt.i. tip/ I TESTER No. I95 -0896 DATE: Phone: (317) 258 -6118 Fax: (317) 65 6 -0087 TIME COMMENTS: r Ayers Backf low Check Service 20 BENNETT ROAD CARMEL, INDIANA 46032 BACKFLOW PREVENTION TEST ADDRESS CITY ZIP B RESIDENCE TELEPHONE i MAKE MODEL SERIAL SIZE j F f.Bc o LOCATION NEXT TEST DATE BY REDUCED PRESSURE ASSEMBLY f� DOUBLE CHECK VALVE J l "�f F rRC PVB CHECK VALVE #1 CHECK SALVE #2 RELIEF VALVE PVB /SVB SVB INITIAL DCDA TEST Held at PSID Held at PSID Opened AIR INLET RPDA at 7 5 PSID Opened AG at PSID AVB Closed tight Did Not Did Not Leaked Leake Qm CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not Leaked Open CLEANED AIR GAP REPLACED Pipe Size Dist. FINAL PSID PSID Opened Air Inlet TEST Closed at PSID PSID tight Check Valve PSID INITIAL TEST BY: TESTER No. I95 -0896 DATE: Phone: (317) 258 6 118 Fax: (317) 566- TIME °d am` COMMENTS: 6� ,�i PS 'i ad D 04J l/ ®A Ayers Backf low Check Service 20 BENNETT ROAD CARMEL, INDIANA 46032 BACKFLOW PREVENTION TEST ADDRESS CITY ZIP BUSS ESIDENCE TELEPHONE s MAKE MODEL SERIAL SIZE L- le- s 97 x4- w by LOCATION NEXT TEST DATE BY REDUCED PRESSURE ASSEMBLY l y V g ^l DOUBLE CHECK VALVE Cl DC PVB CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB /SVB SVB INITIAL DCDA TEST Held at PSID Held at PSID Opened AIR INLET RPDA at D PSID Opened AG at PSID AVB Closed tight Did Not Did Not Leaked Leake QP= QgQ� CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not Leaked Open CLEANED AIR GAP REPLACED Pipe Size Dist. FINAL PSID PSID Opened Air Inlet TEST Closed at PSID PSID tight_ Check Valve fB PSID INITIAL TEST BY: TESTER No. 195-0896 DATE: Phone: (317) 258 6118 Fax: (317 566 0087 TIME COMMENTS: �L q51 e /3 i A;fS Ayers Backf low Check Service 20 BENNEiT ROAD CARMEL, INDIANA 46032 "c0 a` BACKFLOW PREVENTION TEST ADDRESS CITY ZIP BUS�I�NESSS/RIESIDENCE TELEPHONE MAKE MODEL SERIAL SIZE f7g; 2.6� a) 2 i LOCATION NEXT TEST DATE BY REDUCED PRESSURE ASSEMBLY RP DOUBLE CHECK VALVE DC PVB CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB /SVB SVB INITIAL DCDA TEST Held at �1 PSID Held at PSID Opened AIR INLET RPDA at PSID Opened AG at PSID AVB Closed tight X Did Not Did Not Leaked Leaked Open CHECK VALVE AVB REPAIRS CLEANED CLEANED CLEANED Held Open REPLACED REPLACED REPLACED at PSID Not Leaked Open CLEANED AIR GAP REPLACED Pipe Size Ir Dist. FINAL PSID PSID Opened Air Inlet TEST Closed at PSID PSID tight Check Valve PSID INITIAL TEST BY- /`«-n TESTER No. 195 -0896 DATE: Phone: (317) 258 6118 Fax: (317•) 0087 TIME COMMENTS: 1 4'`1 .9 4 .bid A-- '°m. '7� I,� Aph^1 Ayers Backf low Check Service 20 BENNETT ROAD CARMEL, INDIANA 46032 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. 359344 Ayers Backflow Check Ser Terms 20 Bennett Rd Carmel, IN 46032 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 5/25/11 213580 MCC Backflow Prevention tests 150.00 Total 150.00 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 Voucher No. Warrant No. 359344 Ayers Backflow Check Ser Allowed 20 20 Bennett Rd Carmel, IN 46032 In Sum of 150.00 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1093 213580 4350100 150.00 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 16 -Jun 2011 'h Do aya Signature 150.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund