HomeMy WebLinkAbout198428 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:
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ADDRESS ADDRESS 20 Bennett Rd.
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CITY, STATE, ZIP c,9� CITY, STATE, ZIP C armel, 46032
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Purchase
Description
P.O. P or F
r_
Budget
Line Descr
Purchaser Date
-Approval Bat
Ad
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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