176294 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page I of 1
ONE CIVIC SQUARE JACOB- DIETZ, ING
CARMEL, INDIANA 46032 2708 E MICHIGAN ST CHECK AMOUNT: $73.$0
X44 0 `p� INDIANAPOLIS IN 46201 CHECK NUMBER: 176294
CHECK DATE: 8/19/2009
DEPARTMENT ACCOUNT PO NUM I NVOICE NUM v AMO UNT DESCRIPTION
.1120 4350900 49977 73.80 OTHER CONT SERVICES
�r
JACOB-nETZ, Nc. Invoice
F IRE PROTECTION S P E C I A L I STS
2708 East Michigan Street Date Invoice
Indianapolis, IN 46201
317 -631 -2304 Fax 317- 631 -3117 8/13/2009 49977
Bill To: Ship To:
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
P.O. No. Work Order Terms Due Date Rep Project
8/13/2009 Carmel Fire Departm...
Quantity Description Rate Amount
1 10# ABC recharge 25.50 25.50
1 204 ABC recharge 40.50 40.50
1 OR27 Neck o -ring 1.15 1.15
1 OR29 Neck o -ring 1.15 1.15
1 Badger stem 5.50 5.50
Yellow is JDI copy please sign. Subtotal $73.80
White is delivery copy for Customer.
Sales Tax (0.0 $0.00
=Tota $73.80
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))
49977 $73.80
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
VOILIONER NO. WARRANT N
ALLOWED 20
Jacob Dietz
IN SUM OF
2708 East Michigan Street
Indianapolis, IN 46201
$73.80
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept, INVOICE NO. ACCT #FTITLE AMOUNT Board Members
1120 49977 43- 509.00 $73.80 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
AUG 17 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund