169482 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $281.05
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 169482
CHECK DATE: 314/2009
DEPARTMENT ACCOUNT PO NUM BER INVO NU MBER AMOUNT DESCRIPTION
601 5023990 00524637 56.23 OTHER EXPENSES
2201 4232100 00526296 224.82 GARAGE MOTOR SUPPIE
I
i
a
s g'•
ORIGINAL INVOICE
ININ INDIANA OXYGEN COMPANY
-ANA CUSTOMER: 07851. PAGE: I
P.O. BOX 78588 INVOICE: 00526296
BINGEN ORDER: 01132024-00 I
I INV DATE: 02/20/09 i ORD DATE: 02/20/09
INDIANAPOLIS, IN 46278-0588 1
PERSON: 000 TERR! 007
317-290-0003 SALESPERSON_ I 004 INT: JS -7 i
I
plo. SHOP
TERMS: NET 30
SH IP VIA: will Call
RELEASE
B s
I CARMEL STREET DEPT H CARMEL STREET DEPT
L 3400 W 131ST ST 1 p 3400 W 131ST ST
L
WESTFIELD IN 46074 WEISTFIELD IN 46074
T T
0 0
INV OICE AMOUNT! 224.82
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
01 0ry M UNIT ITEM DESCRIPTION U0, -PRICE AMOUNT
,c)c a ti on:
OX 220 2 01 2 2�OXYGFN, COMPRESSED, 2.2 CYL 40.182 80. 36
UN1072
440CF 18.2645/100CF
AL S 2 C) 2 2 ACETYLENE, DISSOLVED, 2.1 CYL 68.78 137.56
UN1001
294CF 46.7891/1000F
RECORD "ACTUAL" CUBIC FOOTAGE
(60 -1 75CF/CYL)
4
1 0 1
FSCFUF,', S'RCl'GVJC'� TLMP DIESEL SURCHARGE VJ/C F', A 3.95
n'
HMCIIAZ 0' C11C, I HAZARDOUS NDITERIAL CHARGE EACH 2.95 2
SubLotal 224.82
i i i I 4
TOTAL �YLTNDERS SHIPPED: 4 RETURNED: 41
www,. indj.aniUXyyULl cUIIL
email invoice@ i
Taxable aniount:; 0.0
CARMEL STREE'.1' DEI?T CUSTOMER: 07851 METRO 224.82
1400 W 131ST ST INVOICE: 00526296
IAIESTFIELD IN 46074 INVOICEDATE: 02/20/09
ORDER: 011.32024-00 PIO: SHOP
INDIANA OXYGEN COMPANY e P.O. BOX 78588 INDIANAPOLIS, IN 46278-0588
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))
02/20/09 00526296 $224.82
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
VO N O. WARRAN N O.
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$224.82
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT
Board Member
2201 00526296 42- 321.00 $224.82 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
Friday, February 27, 200
Street Commissiqper
atrovt
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
rtiv i
ITEM Qry Ory DESCRIPTION UOM 1 UNIT AMOUNT
SHIP'D R!O -PR
RELEASE F_.0
Location: W i
fAC 144 11 C) li 1 COMPRESSED GASES, N.O.S., 2.2 CYL 49.328 49.33
1 UN1956
I 144CF 34.2556/100CF
(75% ARGON 25% CARBON DIOXIDE)
FSCFUEL SRCHGWC 11 0 TEMP DIESEL SURCHARGE W/C EA 3.95 3.95
HMCHA'L MAT CHG 1� 0 1 HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95 V
Subtotal. 56.23
TOTAL CYLINDERS SHIPPED: 1 RETURNED: I
i
ww% i. indiaiiaoxygIm com
emalil invoice @1ndianaoxy en.com
f Taxable amount:) 0.00
CARMEL WATER TREATMENT PLANT CUSTOMER: 12598 56.23
INV THIS
3450 W 131ST ST INVOICE: 00524637 INCLUDING TAX
WESTFIELD IN 460'74 -8267 INVOICEDATE: 02/13/09
ORDER; 01129126 -00 PlO: STEVE CALAHAN 2501
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
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, bates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
154252
INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 Due Date 2/19/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/19/2009 00524637 $56.23
pp�
l�
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with I 5- 11- 10 -1.6
Date Officer
VOUCHER 091167 WARRANT ALLOWED
1
154252 IN SUM OF
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
00524637 01- 6200 -06 $56 -23
h
Voucher Total $56.23
Cost distribution ledger classification if
claim paid under vehicle highway fund