172884 05/27/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $172.05
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 172884
CHECK DATE: 5/27/2009
DEPARTMENT A:(;tOUNT PO NUM BER INV NUMBER AMOUNT DESCRIPTION
2201 4231100 00543522 172.05 BOTTLED GAS
ORIGINAL INVOICE
IN INDIANA OXYGEN COMPANY I 851 P AGE
P.O. BOX 78588 JINVOICE 00543722_ ORDER: 0.1. 162 /19'3 0 0
INV DATE: 0 5 /0 5 0 9 ORDDATE: O�
INDIANAPOLIS, IN 46278-0588
317-290-0003 SALESPERSON: 000 TERR: 00"
IBRANCH: 004 INT: 13 Y-1.
P/O: 5 /5/09
TERMS. NET 30
SHIP VIA: W Cal 1
RELEASE
B S
I CARMEL STREET DEPT H CARMEL S"IRFE'il DEPT
L 3400 W 131ST ST 1 P 3/100 W 131-ST ST
L
WESTFIELD IN 46074 VJ;-STF'IE!;i) IN 46C'74
T T
0 0
INVOICE AMOUNT:
72.
PLEASE SEND TOP PORTION WITH YOUR PAYMENT I
Ty QTY UNIT i
ITEM DESCRIPTION tiom
W PRICE I O1JNT
SHIP'D B J
Location:
AR 336 1' 0 1 1 ARGON, COMPRESSED, 2.2 CYL 99.001 99.00
UN1006
331CF 29.9094/100CF
INW7OS2332X36 10 0� ER70S2 3/32X36" TIC WIRE LB 3.601 56.00
INW7OS2116X36 10 0, ER70S2 1/16X36" TIC WERE LB 3 1 5 J.i 0
5
IFSCFUEL SRCHGWC 1; 0 TEMP DIESEL SURCHARGE WIC
A '.60
HMCHAZ MAT CHG 11 0 HAZARDOUS MATERIAL CHARGE EACH 2.91 2 .95
Sub U C) t a 1 05
TOTAL CYLINDERS SHIPPED: I RETURNED: I
Due to current fuel price 3 IOC
has adjusted th e Fuei Sur7harge
Taxable amountd 0.00
CARMEL STREET DEPT CUSTOMER: 07851 1/2.05
3400 W 131ST ST INVOICE: 005
WESTFIELD IN 46074 INVOICEDATE: 05/05/09
ORDER: 01162495-00 P/O: 5/5/09
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
a
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
05/05/09 00543522 $172.05
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
$172.05
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
2201 00543522 42- 311.00 $172.05 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
Thursp May 21, 2009
Street Commissioner
,d
Cost distribution ledger classification if
claim paid motor vehicle highway fund