212654 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB-DIETZ,INC CHECK AMOUNT: $200.20
CARMEL, INDIANA 46032 2708 E MICHIGAN ST
INDIANAPOLIS IN 46201 CHECK NUMBER: 212654
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239099 55824 200 . 20 OTHER MISCELLANOUS
JACOB DIETZ, INC. lnV®1Ce
FIRE PROTECTION SPECIALISTS
2708 East Michigan Street Date invoice#
Indianapolis, IN 46201
317-631-2304 Fax 317-631-3117 8/20/2012 55824
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
28064 8/20/2012 Carmel Police Depar...
Quantity Description Rate Amount
8 5#ABC recharge 15.50 124.00
1 Gauge o-ring 0.75 0.75
4 OR27 Neck o-ring 1.30 5.20
4 340036K Neck o-ring 2.00 8.00
3 Badger stem 7.00 21.00
4 Kidde stem 5.25 21.00
1 Kidde Valve Stem 5.00 5.00
7 Pull Pin 0.75 5.25
1 Truck charge 10.00 10.00
Pay online at:
littps://Ipn.intuit.com/2kzvp7fp
Subtotal $200.20
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 $200.20
VOUCHER NO. WARRANT NO.
ALLOWED 20
Jacob-Dietz, Inc.
IN SUM OF $
2708 East Michigan Street
Indianapolis, IN 46201
$200.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1110 55824 42-390.99 $200.20
I hereby certify that the attached invoice(s), or
I 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
Wednesday, September 05, 2012
r�
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor 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 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))
08/20/12 55824 fire extinguisher service $200.20
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