179258 11/11/2009 0 ,>�-�y,,f CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
t, ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $226.56
k�;o��o�, INDIANAPOLIS IN 46278 CHECK NUMBER: 179258
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION
2201 4231100 00581467 65.41 BOTTLED GAS
2201 4231100 00584329 91.09 BOTTLED GAS
2201 4231100 08060250 70.06 BOTTLED GAS
CYLINDER RENTAL INVOICE
R, a
Iii )its ?A INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1
P.O. BOX 78588 INVOICE: 08060250
INDIANAPOLIS, IN 46278 -0588 INV DATE: 10/31/09
317 290 -0003 SALESPERSON: 0 0 0 TERR: 007
BRANCH: 004
P /O:
TERMS: NET 30
B CARMEL STREET DEPT H CARMEL STREET DEPT
L 3400 W 131ST ST I 3400 W 131ST ST
L WESTFIELD IN 46074 P WESTFIELD IN 46074
T T
O O
INV AM 70.06
PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
'NV ITEM- _INVOICE DATE.. .INVOICE- BEGINNING SHIP PED RETURNED ENDING LEASED BAUDAYS CYLINDER EXTENDED
rYF" CALANCE C.LINDERS ..ATE .:AUNT
R 050 1 0 0 1 0 31 .310 9.61
R 11X 1 0 0 1 1 0 .310 .00
R 147 3 1 1 3 0 93 .340 31.62
R 220 2 0 0 2 0 62 .310 19.22
R 330 1 0 0 1 0 31 .310 9.61
I
TAX: .00
CARPEL STREET DEPT CUSTOMER: 07851 TOTAL 70.06
3400 W 131ST ST INVOICE: 08060250
WESTFIELD IN 46074 INVOICE DATE: 10/31/09
TOTAL CYL VALUE: 1600.00 P /O:
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
ORIGINAL INVOICE
N 1XAMA INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1 j
P.Q. BOX 78588 INVOICE: 00581467 ORDER: 01222256 -01 j
INDIANAPOLIS, IN 46278 -0588 INV DATE: 10/16/09 ORD DATE: 10
317- 290 -0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 INT: TFS
P /O: JEFF STEWART 417 -5053
TERMS: NET 30
SHIP VIA: UPS
RELEASE MIKE 733 -2001 j
B S
CARMEL STREET DEPT H CARMEL STREET DEPT
3400 W 131ST ST P 3400 W 131ST ST
WESTFIELD IN 46074 WESTFIELD IN 46074
T T
0 0
INVOICE AMOUNT: 65.41
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
_ITEM s �o DESCRIPTION UOM- UNIT AMOUNT-
PRICE `I
RELEASE MIKE 733 -2001 j
Location: D
LIN216- 099 -666 1; 0 kMOTOR, FAN, BALL BEARING EACH 65.41 65.41
Subtotal 65.41
I j j I
I
II I i I j
j j I
I
I I i
Due, to current fuel price3 IOC
I has adjusted the Fuel Sur barge
i
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(Taxable amount: 0.00
CARMEL STREET DEPT CUSTOMER: 07851 65.41
3400 W 131ST ST INVOICE: 00581467
i
WESTFIELD IN 46074 INVOICEDATE: 10/16/09
ORDER: 01222256 -01 P /O: JEFF STEWART 417 -5053
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
ORIGINAL INVOICE
�[NL)L. -XNA INDIANA OXYGEN COMPANY CUSTOMER: 07851 (PAGE: 1
0XVIN P.O. BOX 78588 INVOICE: 0058432 i ORDER: 01231799 -00
INDIANAPOLIS, IN 46278 -0588 INV DATE: 10/29/09 ORD DATE: 10/29/09
317 290 -0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 INT: TIM
P /O: L
TERM NET 30
SHIP VIA: Will Call
RELEASE
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: 91.09
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
ITEM S Q i P DESCRIPTION UOM PRICE AMOUNT
Location: D
AL S j 1i 01 I 1 ACETYLENE, DISSOLVED, 2.1 CYL 84.981 84.98
l UN1001
147CF 57.8102/100CF
i
I RECORD "ACTUAL" CUBIC FOOTAGE
CF i
CF
I i I
(60 -175CF /CYL)
I I
IFSCFUEL SR-CHGWCI 1j 0� TEMP DIESEL SURCHARGE W/C EA 3.16 3.16
'HMCHAZ MAT CHG j 1; 0' HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
Subtotal 91.09
I i
l OTAL CYLINDERS SHIPPED: 1 RETURNED: li
i
I I I
i i i I i i
Due to current fuel price IOC
i has adjusted the Fuel Sur barge
I
I
I I I
Taxable amountd 0.00
CARMEL STREET DEPT CUSTOMER: 07851 91.09
3400 W 131ST ST INVOICE: 00584329
WESTFIELD IN 46074 INVOICEDATE: 10/29/09
ORDER: 01231799 -00 P /O: L.
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
Prescribed by State Board of Accounts City Form No. 2 (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))
10/16/09 00581467 $65.41
10/29/09 00584329 $91.09
10/31 /09 08060250 $70.06
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.
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$226.56
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 00581467 42- 311.00 $65.41 1 hereby certify that the attached invoice(s), or
2201 00584329 42- 311.00 $91.09
bill(s) is (are) true and correct and that the
2201 08060250 1 42- 311.00 $70.06
materials or services itemized thereon for
which charge is made were ordered and
received except
4 Thu 0 sday, Nov 2009
ua"
Street Commissioner Y
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund