210416 07/05/2012 ,\yf CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $169.79
INDIANAPOLIS IN 46278 CHECK NUMBER: 210416
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 00820922 159.28 BOTTLED GAS
1094 4239012 8189973 10.51 SAFETY SUPPLIES
ORIGINAL INVOICE
INDIAN "X INDIANA OXYGEN COMPANY CUSTOM 0'185 1 PAGE: I
P.O. BOX 78588 INVOICE: 00820922 ORDER: 01638693-00
INDIANAPOLIS, IN 46278-0588 INV DATE. 06/19/12 ORD DATE: 06/19/12
317-290-0003
SALESPERSON: 000 ITERR: 007
BRANCH: _IXO 4 INT: MMG
P/O: SHOP
TERMS: NET 30
SHIP VIA: W- Call
RELEASE#:
B S
I CARMEL STREET DEPT H CARMR;l, STREET DEPT
L 3400 w 131ST ST 3400 W 1.31-ST ST
L CARMEL IN 46074 CARMEL IN 46074
T T
0 0
INVOICE AMOUNT: 159.28
PLEASE SEND TOP PORTION WITH YOUR PAYMENT
IT
iTE M DESCRIPTIO LIOM Ul CE -AMOUNT
SHIFD 0 u0m p
Location: D
CD 50 1 0 0 1 CARBON DIOXIDE, 2.2 CYL 19.845 19.85
UN1013
50CF 39.6900/1000Y
AL S 1 0 1 1 ACETYLENE, DISSOLVED, 2.1 CYL 65.178 65.18
UN1001
147CF Ca 44.3388/1000F
PRICE INCLUDES TEMPORARY CARBTDE�
SURCHG
RECORD "ACTUAL" CUBIC FOO"LPACE
CF
CF
(60-175CF/CYL)
.AR 336 1 0I 1 0 ARGON, COMPRESSED, 2.2 CYL 66.15 66.15
UN1006
331CF 19.9849/100CF
FSCFUEL SRCHGWC 1 0 TEMP DIESEL SURCHARGE W/C EA 4.15 4.15
HMCHAZ MAT CHG 1, 0 HAZARDOUS MATERIAL CHARGE I EA 3.95 3.95
Subtotal 159.28
�OTAL YLINDERS SHIPPED: 2 RETURNED: 2i
Visit us at fac--book or oi the
web at indimaoxygen.:=
Taxable amount: 0 .00
CARMEL STREET DEPT CUSTOMER: 0785-1 159.28
3400 W 131ST ST INVOICE: 00820922
CARMEL IN 46074 INVOICEDATE: 06/1-9/1.2
ORDER: 01638693-00 P/O: SHOP
I
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278-0588
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))
06/19/12 00820922 $159.28
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
VOUCHER NO. WARRANT N
ALLOWED 20
Indiana Oxygen
IN SUM OF
P. O. Box 78588
Indianapolis, IN 46278 -0588
$159.28
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. I ACCT /TITLE AMOUNT Board Members
2201 I 00820922 I 42- 311.001 $159.28 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
Thursday; June 28, 2012
UOW4
Street Commissioner
r it
3�reet OmTitlessioner
Cost distribution ledger classification if
claim paid motor vehicle highway fund
PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
NV ITEM INVOICE DAT INVOICE BEGINNING SHIPPED RETIJRNFD ENDING LEASED BAI- /DAYS CYLINDER EXTENDED
TY P E __BEG INNING BALANCE CYLC +CERS i7ATE AMOUNT
R SHP SMALL HIGH PRESSURE 1 0 0 1 0 31 .339 10.51
-E EIVIED
JUN Q 6 2012
urchase
ascription 4dK
.0. �O �r orF
3. 2� 0/2
ua�t �c
ine escr
urchaser Date
pproval Date
TAX: .00
CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL 10- 10.51
1411 E. 116TH ST. INVOICE: 08189973
CARMEL IN 46032 INVOICEDATE: 05/31/17
TOTAL CYL VALUE: 100.00 P /O:
INDIANA OXYGEN COMPANY P.O. BOX 78588 INDIANAPOLIS, IN 46278 -0588
i
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
154252 Indiana Oxygen Company Terms
P.O. Box 78588
Indianapolis, IN 46278 -0588
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
5/31/12 8189973 Rental of oxygen tanks 30205 10.51
Total 10.51
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. Warrant No.
154252 Indiana Oxygen Company Allowed 20
P.O. Box 78588
Indianapolis, IN 46278 -0588
In Sum of
10.51
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1094 8189973 4239012 10.51 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
28 -Jun 2012
Signature
10.51 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund