180458 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $87.70
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 180458
CHECK DATE: 12/16/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
5023990 00591891 78.40 MATERIALS SUPPLIES
601 5023990 08064940 9.30 CONT SERVICES OTHER
IT FM QT QTY i DESCRIPTION ._-.UOM UNIT AMOUNT
sr+ia a;o
_PRIG
Location: D
OX 80 1 0 1 1 OXYGEN, COMPRESSED, 2.2 CYL 18.76 18.76
UN1072
70CF 26.8000 /100CF
AL A75 1 0 1 1 ACETYLENE, DISSOLVED, 2.1 CYL 46.826 46.83
UN1001
81CF 57.8099/1000F
RECORD ACTUAL CUBIC FOOTAGE
I CYLPAINT 11 0I PAINT REPAINT CYLINDER TO IOC EACH 6.50 6.50
SPECIFICATIONS l
FSCFUEL SRCHGWC', 1 l 0
TEMP DIESEL SURCHARGE W/C EA I 3.36 3.36
HMCHAZ MAT CHG j l 0 HAZARDOUS MATERIAL CHARGE EACH 2.95 2.95
Subtotal 78.40
I I I
I I i DOTAL CYLINDERS SHIPPED: 2 RETURNED: 2
1 I
i
I
Due to current fuel price3 IOC
has adjusted the Fuel Sur barge
I I l
j I I I
I il l I
;Taxable amount:i 0.
CARMEL WATER TREATMENT PLANT CUSTOMER: 12598 AMOU O ICE N T 78.40 j
THIS INV
3450 W 131ST ST INVOICE: 00591891
WESTFIELD IN 46074 -8267 INVOICEDATE: 12/03/09
ORDER: 01244782 -00 P /O: MIKE
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 45278 -0588
INV 'BEGINNING ENDING LEASED CYLINDER. EXTENDED.
o _ITEM INVOICE DATE INVOICE BALANCE _SHIPPED RETURNED Bol ANCE BAUDAYS
_CYLINDERS _._,._.RATE AMOUNT
R 020 1- 0 0 1- 0 0 .310 .00
R 144 1 0 0 1 1 0 .310 .00
R 147 1 0 0 1 1 0 .340 .00
R 210 1 0 0 1 0 30 .310 9.30
R 337 1 0 0 1 1 0 .310 .00
w
TAX: .00
CARMEL WATER TREATMENT PLANT CUSTOMER: 12598 9.30
TOTAL
3450 W 131ST ST INVOICE: 08064940
WESTFIELD IN 46074 -8267 INVOICE DATE: 11/30/09
TOTAL CYL VALUE: 800.00 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
r
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 12/7/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/7/2009 08064940 $9.30
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
Date Officer
VOUCHER 093783 WARRANT ALLOWED
154252
IN SUM OF
INDIANA OXYGEN CO
PO BOX 78588�
INDIANAPOLIS, IN 46278
R
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
08064940 01- 6360 -03 $9.30
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1
Voucher Total �'1 '7®
Cost distribution ledger classification if
claim paid under vehicle highway fund