180137 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $138.79
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 180137
CHECK DATE: 12/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION
2201 4231100 00589201 70.99 BOTTLED GAS
2201 4231100 08064458 67.80 BOTTLED GAS
or
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ORIGINAL INVOICE
INDIAKA IN
T DANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 00589201 O RDER: 01240498 -00
INDIANAPOLIS, IN 46278 -0588 INV DATE: 11/19/09 ORD DATE: 11/19/09
317 290 -0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 INT: TIM j
P /O: SHOP j
TERMS: NET 30
7 SHIP VIA: Will Call
RELEASE
1
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
3400 w 131ST ST P 3400 w 131ST ST
WESTFIELD IN 46074 WESTFIELD IN 46074
T T
O O
INVOICE AMOUNT: 70. 99
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
ITEM. QTY Q DESCRIPTION UOM UNIT AMOUNT--
SKP'D P /0 PRICE
Location: D I
OX 220 1 0 1 1 OXYGEN, COMPRESSED, 2.2 CYL i 40.182 40.18
UN1072
220CF 18.2645/1000F
VICO331 -0015 1 0 2 -3 -101 CUTTING TIP EA 24.45 24.45
;FSCFUEL SRCHGWC 11 Oj TEMP DIESEL SURCHARGE W/C EA 3.41 3.41
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
I j I
Subtotal 70.99
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 11
I I I i j i
I i I i i I j
Due to current fuel prices IOC
has adjusted the Fuel Sur harge
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I I
Taxable amount:' 1 0.00
CARMEL STREET DEPT CUSTOMER: 07851 70.99 THIS IN 3400 W 131ST ST INVOICE: 00589201 INCLU j
WESTFIELD IN 46074 INVOICEDATE: 11/19/09
ORDER: 01240498 -00 P /O: SHOP
INDIANA OXYGEN COMPANY o P.O. BOX 78588 INDIANAPOLIS, IN o 46278 -0588
f
CYLINDER RENTAL INVOICE
INDIANA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 08064458
INDIANAPOLIS, IN 46278 -0588 INV DATE: 11/30/09
317 290 -0003 SALESPERSON: 0 0 0 TERR: 007
BRANCH: 004
P /O:
TERMS: NET 3 0
B S
CARMEL STREET DEPT H CARMEL STREET DEPT
L 3400 W 131ST ST 1 3400 W 131ST ST
L P
WESTFIELD IN 46074 WESTFIELD IN 46074
T T
0 O
INVOICE AMOUNT: 67.80
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
INV ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED ENDING I LEASED BAUDAYS CYLINDER EXTENDED
P BAIANCE BALANCE CYLINDERS RATE AMOUNT
R 050 1 0 0 1 0 30 .310 9.30
R 11X 1 0 0 1 1 0 .310 .00
R 147 3 0 0 3 0 90 .340 30.60
R 220 2 1 1 2 0 60 .310 18.60
R 330 1 0 0 1 0 30 .310 9.30
TAX: .00
CARMEL STREET DEPT CUSTOMER: 07851 TOTAL 67.80
3400 W 131ST ST INVOICE: 08064458
WESTFIELD IN 46074 INVOICE DATE: 11/30/09
TOTAL CYL VALUE: 1600.00 P /O:
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, 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))
11/19/09 00589201 $70.99
11/30/09 08064458 $67.80
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
VOU NO. WARRANT NO.
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$138.79
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member
2201 00589201 42- 311.00 $70.99 1 hereby certify that the attached invoice(s), or
2201 08064458 42- 311.00 $67.80 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
t ;i
j �Friday,!:December 04, 2009
Street Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund