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178728 10/28/2009 a CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1 ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $479.04 CARMEL, INDIANA 46032 PO BOX 78588 INDIANAPOLIS IN 46278 CHECK NUMBER: 178728 CHECK DATE: 10/28/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A DESCRIPTION 2201 4231100 00578861 35.37 BOTTLED GAS 2201 4231100 005789166 27.70 BOTTLED GAS 2201 4231100 00581102 415.97 BOTTLED GAS ORIGINAL INVOICE W&XNA INDIANA OXYGEN COMPANY CUSTOMER: 0785 PAGE: 1 P.O. BOX 78588 INVO 005 j O RDER: 01221513 -00 INDIANA IN 46278 -0588 INV DAT 1 0 /06 09 ORD DATE 1 0/ 0 2/09 000 TERR: 317 290 -0003 SALESPERSON 007 BRANCH: 001. INT: BAM P /O: SHOP TERMS: NET 30 SHIP VIA UPS RELEASE f 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 O O INVOICE AMOUNT: 35.37 PLEASE SEND TOP PORTION WITH YOUR PAYMENT ITEM sOTY 9/0 oTV I DESCRIPTION_ UOM_r___PRICE AMOUNT- __._L- BIC Location: W MIP200258 2 0 NOZZLE,SLIP TYPE .500 ORF FLUSH EA 13.56 27.12 Subtotal 27.12 I i i I I I 1 i I I Due to cuzrent fuel price3 IOC Freight 8.25 has adjusted the Fuel Sur barge j 1 j Taxable amount 0.00 CARMEL STREET DEPT CUSTOMER: 07851 35.37 3400 W 131ST ST INVOICE: 00578861 WESTFIELD IN 46074 INVOICEDATE: 10/06/09 ORDER: 01221513 -00 P /O: SHOP INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588 ORIGINAL INVOICE CNDIAN INDIANA OXYGEN COMPANY CUSTOMER: 07851 PAGE: 1 k P.O. BOX 78588 INVOICE: 00 579166 i ORDER: 01_2 -00 INDIANAPOLIS, IN 46278 -0588 INV DATE: 10/07/09 ORD DATE: 10/06/09 317 290 -0003 SALESPERSON: 000 TERR: 007 BRANCH: 004 T INT: TFS P /O: JEFF STEWART TERMS: NET 30 SHIP VIA: UPS RELEASE SHOP 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 O O INVOICE AMOUNT: 27.70 PLEASE SEND TOP PORTION WITH YOUR PAYMENT ITEM won a/0 DESCRIPTION UOM UNIT, AMOUNT. ..HiP ago-. PRICE- RELEASE SHOP Location: 1 MIP169725 2 0 NOZZLE,SLIP TYPE .625 ORF .125 EACH 13.85 27.70 RECESS I Subtotal 27.70 j I I I I I i i I i i I I j Due to current fuel price IOC I has adjusted the Fuel Sur harge i I I Taxable amount:' 0.00 CARMEL STREET DEPT CUSTOMER: 07851 27.70 M 3400 W 131ST ST INVOICE: 00579166 WESTFIELD IN 46074 INVOICEDATE: 10/07/09 ORDER: 01222766 -00 P /O: JEFF STEWART INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588 ORIGINAL INVOICE N'I)LIN -A INDIANA OXYGEN COMPANY C USTOMER: 07851 PAGE: 1 P.O. BOX 78588 INVOICE: 005 81102 ORDE 01 226014-00 j INDIANAPOLIS, IN 46278 -0588 INV DATE: 10/15/09 I ORD DATE: 10/14/09 317- 290 -0003 SALESPERSON: 000 TERR: 007 BRAN 004 INT: TIM P /O: MIKE TERMS: NET 30 SHIP VIA: Will Call j RELEASE B S I CARMEL STREET DEPT H CARMEL STREET DEPT 3400 W 131ST ST F 3400 W 131ST ST WESTFIELD IN 46074 WESTFIELD IN 46074 T T O O INVOICE AM 415.97 PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------- -ITEM,- QTY QTY DESCRIPTION UOM UNIT AMOUNT PRICE Location: D 'OKICABI -250 150 WELD CABLE #1 AWG 250' REEL FT 2.30 345.00 OKIPEAPGC -300 1 Oil GROUND CLAMP COPPER EACH 29.34 29.34 ITWEA532 1 0 TWECOTONG ELECTRODE HOLDER EA 38.07 38.07 I ITWET62 2 OI 1 POWER CABLE LUG EA 1.78 3.56 TIL1421XL 0� 1 kgloves PR 6.95 0.00 Subtotal 415.97 1 I 1 i I I I I i I I I i i I Duel to current fuel price IOC has adjusted the Fuel Sur barge I I !Taxable amount: 10.00 CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT 415.97 THIS INVOICE 3400 W 131ST ST INVOICE: 00581102 1 INCLUDING TAX WESTFIELD IN 46074 INVOICEDATE: 10/15/09 ORDER: 01226014 -00 P /O: MIKE INDIANA OXYGEN COMPANY m P.O. PDX 78588 9 INDIANAPOLIS, IN o 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)) 10/06/09 00578861 $35.37 10/07/09 005789166 $27.70 10/15/09 00581102 $415.97 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 VOUCHER NO. WARRANT N ALLOWED 20 Indiana Oxygen IN SUM OF P. O. Box 78588 Indianapolis, IN 46278 -0588 $479.04 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members 2201 00578861 42- 311.00 $35.37 1 hereby certify that the attached invoice(s), or 2201 005789166 42- 311.00 $27.70 bill(s) is (are) true and correct and that the 2201 00581102 1 42 311.00 $415.97 materials or services itemized thereon for which charge is made were ordered and received except Thursday, October 22, 2009 J ill S�reet Co m I sl ,�T;t>�:, .r Street C�.;,�:��,slo7er Cost distribution ledger classification if claim paid motor vehicle highway fund