176801 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
t ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $96.89
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 176801
CHECK DATE: 9/2/2009
DEPARTMENT A CCOUNT PO NUMBER IN NUMBER AMOUNT DESCRIPTION
601 5023990 00565237 46.15 OTHER EXPENSES
601 5023990 00567456 50.74 OTHER EXPENSES
_ITEM ory ory DESCRIPTION--- UOM UNIT AMOUNT-
sHIPO r�o PRICE
Location: D
I
NI 210 1 0 1 0 NITROGEN, COMPRESSED, 2.2 CYL 40.194 40.19
i
UN1066
210CF 19.1400 /100CF
IFSCFUEL SRCHGWCJ 1 0, TEMP DIESEL SURCHARGE W/C EA 3.01 3.01
!HMCHAZ MAT CHG 1 0; HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
Subtotal 46.15
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 0
1
I
i I
Due to current fuel prices IOC
i
has adjusted the Fuel Sur barge
I I
i
Taxable amount: 0.00
CARMEL WATER TREATMENT PLANT CUSTOMER: 12598 46.15
3450 W 131ST ST INVOICE: 00565237
WESTFIELD IN 46074 -8267 INVOICEDATE: 08/07/09
ORDER: 01199013-00 P /O:
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
ITEM _SQIP� B/o AMOUNT
DESCRIPTION UOM PRICE
Location: D
NI 210 1 0 1 1 NITROGEN, COMPRESSED, 2.2 CYL 40.194 40.19
UN1066
210CF 19.1400 /100CF
I
OKIFUL4501 1 0 SPARK LIGHTER TRI FLINT 10 /BX EA 4.59 4.59
FSCFUEL SRCHGWC 1 01 TEMP DIESEL SURCHARGE W/C EA 3.01 3.01
i
jHMCHAZ MAT CHGI 1i 0i HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
Subtotal 50.74
I i
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 1
I
Due to current fuel price IOC
has adjusted the Fuel Sur barge
I
I i
Taxable amount:) 0.00 1 1
CARMEL WATER TREATMENT PLANT CUSTOMER: 12598 50.74
3450 W 131ST ST INVOICE: 00567456
WESTFIELD IN 46074 -8267 INVOICEDATE: 08/18/09
ORDER: 01202754 -00 P /O: OPERATIONS FACILITY
INDIANA OXYGEN COMPANY o P.O. BOX 78588 o 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 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 8/26/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/26/2009 00567456 $50.74
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
lo
Date Officer
VOUCHER 092849 WARRANT ALLOWED
154252
IN SUM OF
INDIANA OXYGEN CO .01
Pb BOX 78588 .0)
INDIANAPOLIS, INDIANAPOLIS, IN 46278 Q
R
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
00567456 01- 6200 -06 $50.74
bast, 5-,a3? 61 faZ D(p 4 t5
Voucher Total Gjj
Cost distribution ledger classification if
claim paid under vehicle highway fund