HomeMy WebLinkAbout176096 08/18/2009 CITY OF CARMEL, INDIANA VENDOR: 354308 Page 1 of 1
ONE CIVIC SQUARE ANDREA STUMPF
0 CHECK AMOUNT: $126.61
CARMEL, INDIANA 46032 1225 N ALABAMA UNIT A
INDIANAPOLIS IN 46202 CHECK NUMBER: 176096
CHECK DATE: 8/1812009
DEPARTMENT ACCOUNT PO NUMBER I NVOICE N UMB E R A DESCRIPTION
902 4359003 126.61 FESTIVAL /COMMUNITY EV
v 1
8/12/2009 2:25 PM FROM: IOC FAX TO: +1 (317) 571 -2789 PAGE: 001 OF 001
INDIANA OXYGEN COMPANY, INC.
P.O. BOX 78588 U nT TICKET
INDIANAPOLIS, INDIANA 46278-0588
Bloomington Cincinnati 0 Fishers o Indianapolis
(812) 330 -9210 (513) 353.2448 (317) 641 -0002 (317) 290 -0003
Lafayette i Marion Muncie Seymour 4 Vincennes
OF
(765)474. 7095 (765) 662 -8700 (765)289.2373 (812) 522 -4421 (812) 882-4323
tmerica's Oldest GasMidding Supply 1985006537
CUSTOMER 21366
ORDER 0 1187578-00
CARMEL ART DESIGN DISTRICT
111 W MAIN ST ORDER DATE 07/09/09
CARMEL IN 46032 PANE 001 OF 041
000- 571 -5797
AME CARD]. ART DESIGN DISTRICT TERR 001 SHIP VIA Our Truek -NONE- INITIALS LIE I
A.1 SALES NO SHIP CODE 00 UPS 0 ORDER TYPE CASH -COD
EL f WtMCH 001 COLIPPD PREPAID nME 09-JUL-09 110AN
HONE# W571 -2797 ROUTE# USERNAME t01S
SHIP HAZARD am NUMBER NO NUK" ORDER SHIP IETN WEIGHT AA}UNT AMOUNT
;HIIIIIIH10 COD am mil f
1 CYL Helium, Compressed, 2.2, LW1046 1 HE 240 1 1 200 99.700 99.70
d I25. 00
(HELIUM BALLOON ffADE 200CF)
(CGA580-NDT FOR INDUSTRIAL USE) i
PLEASE NOTE THAT TEE WILL BE A RENT(E CHARGE OF
12.00 PER DAY AFTER 3 DAYS IF YOU DO NOT HAVE A
HELIUM RENTAL CONTRACT WITH US.-
QTY UNIT HI( DEraCJtIPTIM LINE ITEM LOC MY M DIN WEIGHT UNIT EXTENDED
SHIP 6 HAZARD CLASS NO 0w ORDER BHORD LOC AMOUNT AMOUNT
1 EA TEND DIESEL. SUMRfE OUR TIC}( 2 FSC FUEL RIRCHRGi W 1 0 100 3.71 3.71
1 io HAZARDS MATERIAL CHARGE 3 K HAZ K4T GHS W 1 0 .00 2.95 2.95
Total Weight. 125.0000 Subtotal 106.36 I
l
Tax
Freight 20.25
otal 1(% .5
t I
°ECIAL INSTRUCTIONS- PLACARDS: a ACCE a REFUS D
31ERGENCY RE&Wff TELEPHONE (+BEER. 800&1=2 TERMS CONDITIONS
THE CUSTOMER HEREIN CONSENTS TO AND ACCEPTS THE ABOVE PRODUCTS
SUBJECT TO OF THE CONDITIONS AS SET FORTH ON REVE E SIDE HEREOF
THE EXITING CONTRACT BETWEE 8 ES,
tMPQRTANI x f 0
.EASE READ CAREFULLY THE TERMS AND CONDITIONS OF SALE WHICH APPEAR REOEIV BY r16NA7(M DATE
Id THE REVERSE SIDE OF THIS DOCUMENT. ALL SALES MADE ARE SUBJECT TO
JCH TERMS AND CONDITIONS. CUSTOMER SIGNATURE HEREON VERIFIES x
4PPEO AND RETURNED RENTAL CYLINDER COUNT. SHIPPED By
0RIGINA
Page I of I
Transaction Date: 07/10/2009 Fri
11..11... 11...11._
Transaction Description: INDIANA OXYGEN INDY INDIANAPOLIS
3172900003
Description Price
CHl LS/ALLIED PR 133.59
Amount 337.519
Doing Business As: A OXYGEN CO INC
Merchant Address: 6099 CORPORATE WAY
INDIANAPOLIS
IN
INDIANAPOLIS
46278-2923
UNITED STATES
Reference Number: 320091920003421986
Category: Merchandise Supplies General Retail
htt<s: �stmt/us/does/print doe.htm] 8/10/2009
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
eck Tt/ rn Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
-v q
01 7 S 7 v 6 l
1
i
�t
•r
J
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same'ih' %accordance
with IC 5- 11- 10 -1.6. `d
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
A ALLOWED 20
F IN SUM OF
7oac IL Ay
1 f�Apl 5. I ICJ q (D o20 2
ON ACCOUNT OF APPROPRIATION FOR
gvz/ �/3S�oo3
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�U Z 61 I F 7 S 7 q35 y003 /a (o. I 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
9
Signature
Director of Operat
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund