206708 02/28/2012 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
�a CARMEL, INDIANA 46032 PO BOX 76588 CHECK AMOUNT: $24.56
INDIANAPOLIS IN 46278 CHECK NUMBER: 206708
CHECK DATE: 2128/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 00785846 24.56 OTHER EXPENSES
OIV OTY
ITEM DESCRIPTION UOfv1` -UNIT AMOUNT
sH1P•D ero PRICE
Location: W I
OX 80 1 0 1 1 OXYGEN, COMPRESSED, 2.2 CYL 16.538 16.54
UN1072
70CF 23.625 "7 /100CP
FSCFUEL SRCHGWC 1 0 TEMP DIESEL SURCHARGE WIC EA 4.07 4.07
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARD EACH 3.95 3.95
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j Subtotal. 24.56
TOTAL IYLINDERS SHIPPED: 1 RETURNS'D: i
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Taxable amount: 10.00
CARMEL WATER CUSTOMER: 12598 AMOUNT 24.56
THIS INVOICE
3450 W 131ST ST INVOICE: 00785846 INCLU
CARMEL IN 46074 -8267 INVOICEDATE: 02/1.0/7.2
ORDER: 01578684 -00 PIO:
INDIANA OXYGEN COMPANY F.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
VOUCHER 113802 WARRANT ALLOWED
154252 IN SUM OF
INDIANA OXYGEN CO
PO BOX 78588 WATER
INDIANAPOLIS, IN 46278 OPERA -noNS
J
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
00785846 01- 6360 -03 $24.56
Voucher Total $24.56
Cost distribution ledger classification if
claims paid under vehicle highway fund
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 2/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/20/2012 00785846 $24.56
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
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Date 'cer