179733 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB- DIETZ, INC
e/o CHECK AMOUNT: $668.32
CARMEL, INDIANA 46032 2708 E MICHIGAN ST
INDIANAPOLIS IN 46201
CHECK NUMBER: 179733
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 W09028 50480 668.32 BOARD
r. q
JAcoB-DiETz, INC. Invoice
F I R E P R O T E C T I O N SPEC I A L I S T S
2708 East Michigan Street Date Invoice
Indianapolis, IN 46201
317 -631 -2304 Fax 317 631 -3117 10/30/2009 50480
Bill To: Ship To:
Carmel Utilities Water Plants
760 3rd Avenue SW'
Carmel, IN 46032
O
P.O. No. Work Order Terms Due Date Rep Project
10/30/2009 Carmcl Utilities
Quantity Description Rate Amount
5 Air pack cylinder h 15.00 75.00
5 MSA o -ring 5.00 25.00
5 Flow Test 49.95 249.75
4 Audi -Alarm Bell Screw 14.05 56.20
3 MMR Audilarm Kit 23.50 70.50
1 Piston Assembly, Warning 121.87 121.87
1 Hour Labor 70.00 70.00
Subtotal $668.32
Sales Tax (0.0 $0.00
Total $668.32
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER Z.
CITY OF CARMEL t
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. 0
Payee
351351
JACOB- DIETZ, INC. Purchase Order No.
2708 E. Michigan St. Terms
Indianapolis, IN 46201 Due Date 11/16/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/16/20M 50480 $668.32
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
1 I Z`� C t/ j?1' f'q-, a
Date Officer
VOUCHER 09357E7 VVARRANT ALLOWED
35 {1351 IN SUM OF
EP
JACOB- DIETZ, INC. VI
2108 E. Michigan St.
Indianapolis, IN 46201 W
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
50480 01- 6360 -03 $668.32
Voucher Total $668.32
Cost distribution ledger classification if
claim paid under vehicle highway fund