213962 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $109.87
INDIANAPOLIS IN 46278 CHECK NUMBER: 213962
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 07011112 99 . 70 OTHER EXPENSES
1094 4239012 8206609 10 . 17 SAFETY SUPPLIES
INV 'TFM - INVOICE DATE INVOICE- BEGINNING RHIPPED RETURNED ENDING LEASED ggUDAYS CYLINDER EXTENDED
YP- -BALANCE BALANCE CiLINDERS ,.5.?E AMOUNT
R SHP SMALL HIGH PRESSURE 1 0 0 1 0 30 .339 10.17
OCT 0.2 2012
Purchase
Description I�
P.O.# 30 QC) F
G.L.# O
Budget
Line Descr
Purchaser Da e
Approval -Dale
TAX: . 00
CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL ® 10.17
1411 E. 116TH ST. INVOICE: 08206609
CARMEL IN 46032 INVOICEDATE: 09/30/12
TOTAL CYL VALUE: 100 . 00 P/O:
INDIANA OXYGEN COMPANY ® P.O. PDX 78588• INDIANAPOLIS, IN a 46278-0588
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
9130/12 8206609 Rental of oxygen tanks Sep'12 30205 $ 1017
Total $ 10.17
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.
i
154252 Indiana Oxygen Company : Allowed 20
P.O. Box 78588
Indianapolis, IN 46278-0588
In Sum of$
$ 10.17
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#MTL AMOUNT Board Members
Dept ept#
1094 8206609 4239012 $ 10.17 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
18-Oct 2012
Signature
$ 10.17 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
INV 6Ur^ ROT PERIOD DATE - __.__. —DG$cR!f PT -- -- --- 1 CYI. RATE AMOUNT
TYPE GROUP DATE LEASED
L AC1 MIX 12 10/2012 07011112 1 99 .70 99.70
i
I
I
i
I
i
I
I
E OFFER 1 YEAR AND 5 YEAR LEASES
YR $1 2 . 19 PE 11, CYL (ACETYLENE=$209 . 16) PLUS TAX _
CARMEL WATER CUSTOMER: 12598 99 .70
TOTAL
3450 W 131ST ST INVOICE: 0701.11.17 I_-_-
CARMEL IN 46074-8267 INVOICEDATE: 10/1.0/1-2
P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INllIANAPOLIS, IN 46278-0588
VOUCHER # 122436 WARRANT # ALLOWED
154252 IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
07011112 01-6360-03 $99.70
Voucher Total $99.70
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
154252
INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 Due Date 10/16/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/16/201: 07011112 $99.70
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
Date Officer