178806 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 363381 Page 1 of 1
g� z ONE CIVIC SQUARE ON SITE GAS SYSTEMS, INC CHECK AMOUNT: $488.00
®ia CARMEL, INDIANA 46032 35 BUDNEY ROAD
NEW NGTON CT 06111 CHECK NUMBER: 178806
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4353099 13240 488.00 OTHER RENTAL LEASES
-02 12 MTE On Sole Gas Systems, Inc.
Manufactures Designers of Oxygen Nitrogen Generating Equipment
35 Budney Road, Budney Industrial Park, Newington, CT 06111 USA
Telephone 860.667.8888 Fax: 860.667.2222 www.onsitegas.com
Invoice Number: 13240
§gT V ®��G Invoice Date: 10/14/2009
Page: 1 of 1
B CITY OF CARMEL S CARMEL FIRE DEPT
I ONE CIVIC SQUARE H 2 CIVIC SQUARE
L CARMEL IN 46032 -2584 I CARMEL IN 46023
L USA P USA
T T
O O
Order Purchase Order Packages Prepaid Weight Ship Via Terms
L000000O14 12667 WA DUE UPON RECIEPT
Qty Rack
Line /Rel Qty Ordered Shipped Order Date Shipped Unit Price Extended Price
1 1.00 EA 1.00 0.00 8/7/09 488.00 488.00
Customer Item: Lease Oct 7, 2009 thru Nov 7. 2009
Item: L- 02FS -7
Serial 5362
Sales Amountl 488.00
Misc Charges 0.00
Freight gam®p 0 00
Total, 48800
r v cae
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))
13240 $488.00
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
20
Clerk- Treasurer
VOUCHER`: NO. WARRAN NO.
On Site`Gas Systems, Inc. ALLOWED 20
IN SUM OF
35 Budney Road
Newington, CT 06111
$488.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
1120 13240 43- 530.99 $488.00 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
OCT 2 6 2009
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund