212268 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB-DIETZ, INC
CARMEL, INDIANA 46032 2708 E MICHIGAN ST CHECK AMOUNT: $88.45
INDIANAPOLIS IN 46201
CHECK NUMBER: 212268
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239099 55776 88 . 45 OTHER MISCELLANOUS
JDJACOB-DIETZ,
INC. Invoice
PROTECTION SPECIALISTS
2708 East Michigan Street Date . Invoice#
Indianapolis, IN 46201
317-631-2304 Fax 317-631-3117 7!31!2012 55776
Bill To: Ship To:
Carmel Police Department Carmel Police Department
3 Civic Square 3 Civic Square
Carmel, IN 46032 Carmel, IN 46032
P.O.No. Work Order# Terms Due Date Rep Project
25509 8/2/2012 Carmel Police Depar...
Quantity Description Rate Amount
2 5#ABC recharge 15.50 31.00
1 10#ABC recharge 25.50 25.50
2 OR27 Neck o-ring 1.30 2.60
1 340036K Neck o-ring 2.00 2.00
1 Gauge o-ring 0.75 0.75
1 Amerex stem 6.00 6.00
1 Badger stem 7.00 7.00
1 Kidde Valve Stem 5.00 5.00
1 195 psi dry chemical gauge 7.85 7.85
1 Pull Pin 0.75 0.75
Pay online at:
https:Hipti.intuit.com/jg7sr9fg
Subtotal $88.45
Sales Tax(0.0%) $0.00
If not paid by due date,late charges will be assessed at the rate of 1.5%per month. Total $88.45
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))
07/31/12 55776 fire extinguisher service $88.45
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 NO.
Jacob-Dietz, Inc. ALLOWED 20
IN SUM OF $
2708 East Michigan Street
Indianapolis, IN 46201
$88.45
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1110 55776 42-390.99 $88.45 I 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, August 23, 2012
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund