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204850 12/20/2011
CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1 ONE CIVIC SQUARE INDIANA OXYGEN CO CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $9.87 INDIANAPOLIS IN 46278 CHECK NUMBER: 204850 CHECK DATE: 12/20/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1094 4239012 8165007 9.87 SAFETY SUPPLIES INV ITEM LdVOICE LIATE INVOICE BEGINNING cuippEp_ pr� _FNDING LFASEC BAI MAYS CYLINDER EXTENDED yp BALANCE iJALANCF GYLI RAIt AMOUNT R SHP SMALL HIGH PRESSURE 1 0 0 1 0 30 .329 9.0 i l I P,:rc rips on Gr: script on P.:J. P r F t ilx:�� 0r ©i S c Purchas ar I late f,3p1 ate I I 1 TAX: .00 CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL 9.87 1411 E. 116TH ST. INVOICE: 0816500'7 CARMEL IN 46032 INVOICE DATE: 11 3 0 1.1. TOTAL CYL VALUE: 2. 0 0 0 0 P(O: INDIANA OXYGEN COMPANY F.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588 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. 154252 Indiana Oxygen Company Terms P.O. Box 78588 Indianapolis, IN 46278 -0588 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 11/30/11 8165007 Oxygen tank rental 9.87 Total 9.87 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. 154252 Indiana Oxygen Company Allowed 20 P.O. Box 78588 Indianapolis, IN 46278 -0588 In Sum of 9.87 ON ACCOUNT OF APPROPRIATION FOR 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1094 8165007 4239012 9.87 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 15 -Dec 2011 Signature 9.87 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund