205206 01/05/2012 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB- DIETZ, INC CHECK AMOUNT: $110.30
s CARMEL, INDIANA 46032 2708 E MICHIGAN ST
INDIANAPOLIS IN 46201 CHECK NUMBER: 205206
CHECK DATE: 1/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4351501 54587 110.30 EQUIPMENT MAINT CONTR
JACOBDIETZ, INC. z� Invoice
FIRE P ROTE C T i ON S P E C I A L I S TS
2708 East Michigan Street Date Invoice 4
Indianapolis, IN 46201
31.7 631 -2304 fax 317 631 -3117 1.2/28/2011 54587
Bill To: Ship To:
City of Carmel Carmel City Building
One Civic Square
Carmel, IN 46032
P.O. No. Work Order ff Terms Due Date Rep Project
12/28/2011 Carmel City Building
Quantity Description Rate Amount
1.9 Fire Extinguisher annual inspection 3.00 57.00
2 5# ABC hydrotest 13.65 27.30
2 OR27 Neck o -ring 1.30 2.60
2 Badger stem 6.00 12.00
2 Hazardous Material Communication Label 0.70 1.40
1 Truck charge 10.00 10.00
Pay online at:
https://ipn.intuit.com/kff
Dz'
JAN 4 2012
By
Subtotal $110.30
Sales Tax (0.0 $0.00
if not paid by due date, late charges will be assessed at the rate of 1.5% per month. Total $110.30
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jacob Deitz, Inc.
IN SUM OF
2708 East Michigan Street
Indianapolis, IN 46201
$110.30
ON ACCOUNT OF APPROPRIATION FOR
Administration De artmen
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1205 54587 43- 515.01 $110.30
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
Wedn January 04, 2 2
Director, A ministration
Title
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))
12/28/11 54587 $110.30
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
20
Clerk- Treasurer