216085 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
` ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $127.23
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 216085
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 00873351 76 .23 BOTTLED GAS
601 5023990 01721363 51 . 00 OTHER EXPENSES
ORIGINAL INVOICE
N
[ 1i� TT A INDIANA OXYGEN COMPANY CUSTOMER: C'/857. _PAGE:
IN
"� �: _� P.O.BOX 78588 INVOICE: 00873351 i ORDER: - 01125637-00
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INDIANAPOLIS,IN 46278-0588 INV DATE_: 12/28/12 !ORD DATE:112/28/12
317-290-0003 SALESPERSON: '000 TERR: 007
BRANCH: O0/1 INT: MMG
TERMS:
SHIP VIA: W.1 1.1 Call
RELEASE#:
B S
I CARMEL STREET DEPT F1 CAiZMi'; , STREET DEPT
L 3400 W 131ST ST P 3+00 W 1.31ST ST
L
CARMEL IN 46074 CARMEL -IN 46074
T T
O O
INVOICE AMOUNT: 76.23
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
—ITS�.; OTY OrY JESCRIPTIn": UOM UNIT AMOUNT -`
SHIP'D B/0 — ---PRIG--
** Location: D **
AC 75/25 1 0 1 1 ARGON,CARBON DIOXIDI 75/25 38�C17 CY1, 67.804 67.80
INDUSTRIAL GAS MIX CGA580
I
384CF @ 17.6573/1000!
I
IFSCFUEL SRCHGWC 1I 01 TEMP DIESEL SURCHARGIE WIC EA 4.48 4.48
HMCHAZ MAT CHG 1 O' HAZARDOUS MATERIAL, CiiAHG:? !EA 3.95 , 3.95
I
Sub:_oz,a=! 76.23
TOTAL CYLINDERS SHIPPED:
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-Taxable amount:i_ !0.00-I-___I— --_-
CARMEL STREET DEPT CUSTOMER: 07851- ° ° 76.23
3400 W 131ST ST INVOICE: 008•/3351
1. INCLUDINGTAx-
CARMEL IN 46074 INVOICEDATE: 12/28/12
ORDER: 0172563•/-00 P/O: SHOP
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588
VOUCHER NO. WARRANT NO.
ALLOWED 20
Indiana Oxygen
IN SUM OF $
P. O. Box 78588
Indianapolis, IN 46278-0588
$76.23
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 1 00873351 1 42-311.001 $76.23 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
Iday, January 04, 2013
vStreet Commissioner
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))
12/28/12 00873351 $76.23
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
UNIT
ITEM DESCRIPTION UOM AMOUNT
PRICE
Location: IS
i EA 36.00 36.00
MIL300613 1 1 X-CLAMP FOR ARCSTA'1'1:01\1
** Location: 1A ** 15.00 15.00
HAR4705008 1 0 MATADOR 8-WAY PLIt"IRS EA
(PRMYS-50)
S b 51.00
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web; at w1ww.ind anaoxygen. om
Taxable amount:; i0.00
CARMEL WATER CUSTOMER: 12598 AM•U OICE NT. 51.00
THIS INV
3450 W 131ST ST INVOICE: 008'/0333
INCLUDINGTAk
CARMEL IN 46074-8267 INVOICE DATE: 12/
ORDER: 0 TV 363 C, P/O:
INDIANA OXY GEN COMPANY P.O.BOX 78588• INDIANAPOLIS, IN 46278-0588
VOUCHER # 123133 WARRANT # ALLOWED
154252 IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
f
Board members
PO # INV# ACCT# AMOUNT Audit Trail Code
01721363 01-6200-06 $51 00
l
Voucher Total $51.00
t
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 12/29/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/201: 01721363 $51.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
11,1113 f)A,
Date Officer