216748 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
' ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $441.04
INDIANAPOLIS IN 46278
CHECK NUMBER: 216748
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 00877683 123 . 84 OTHER EXPENSES
601 5023990 00877684 8 . 95 OTHER EXPENSES
2201 4231100 00878987 297 . 74 BOTTLED GAS
1094 4239012 8219042 10 . 51 SAFETY SUPPLIES
ITEM OTY OTY DESCRIPTION TU_OM UNIT AMOUNT
** Location: A ** I 1
OX 150 1 01 11 1 OXYGEN, COMPRESSED, 2.2 CYL 12.00 12.00
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UN1072
155CF @ 7.7419%1.000F
MIP192052 5 0 TIP EXTENDED 40A. (5PK) TCE40 EA 4.71 23 .55
1 ICE55 TORCH 625XTREME; 2050/
KISKC2803544 44 01 70S6 .035 X 44# SPL LB 1.82 80.08
I 7056035x44 #SPOOL I
IFSCFUEL SRCHGWCI 11 0 TEMP DIESEL SURCHARGE WIC EA 1 4.26 4.26
iHMCHAZ MAT CHG 1 1 0 HAZARDOUS MATERIAL CHARGE EA 1 3.95 3.95 I
Subtotal 123.84
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TOTALYLIiERS SHIPPED: 1 RETURNED: 1
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Taxable amount: 0.00
CARMEL WATER CUSTOMER: 12598 AMOUNT 123.84 j
THIS INVOICE
3450 W 131ST ST INVOICE: 00877683
CARMEL IN 46074-8267 INVOICEDATE: 01/15/13
ORDER: 01732342-00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
�QI ao DESCRIPTION UOM I PRNCE AMOUNT
** Location: A ** I -------- ----- —
MIP231411 5 0 LENS COVER (5PK) 4-1/2X3-3/4 EA 1.79 8.95
COVERPLATE E/C/ i
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Subtotal 8.95
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Taxable amount: 10.00
CARMEL WATER CUSTOMER: 12598 AMOUNT 8,95 THIS INVOICE
3450 W 131ST ST INVOICE: 008 77684 i
CARMEL IN 46074-8267 INVOICEDATE: 01/15/1.3 INCLUDING TAX
ORDER: 01732351.-00 P/O:
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 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 1/22/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/22/2013 00877684 $8.95
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
)2L-S/!3
Date Officer
VOUCHER # 123320 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
00877684 01-6200-06 $8.995 /
Voucher Total 1 �a
Cost distribution ledger classification if
claim paid under vehicle highway fund
ORIGINAL INVOICE
INDIAN.1k INDIANA OXYGEN COMPANY CUSTOMER: 0_785_1 -- !PAGE: 1
P.O.BOX 78588 INVOICE 00878987 J ORDER: 01731496-00
INDIANAPOLIS,IN 46278-0588 INV DATE: 01/18/13 ORD DATE: 01/14/13
317-290-0003 SALESPERSON: 000 j TERR: 007
BRANCH: 004 TINT: DAB
P/O: VERBAL: MIKE HENRICKS
TERMS: NET 30
SHIP VIA_: Direct Ship
RELEASE#:
B S
I CARMEL STREET DEPT H CARMEL, STREET DEPT
L 3400 W 131ST ST P ALT: MIKE HENRICKS
L
CARMEL IN 46074 3400 W. 131ST ST.
T T CARMEL, IN 46074
O O
INVOICE AMOUNT: 297.74
-------------------------------------------PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
ITEM OTV 0TY DESCRIPTION UOM I UNIT AMOUNT
SHIP'D 6/0 PRICE
** Location: D **
NAS100AB-4000-71 1 0 kANCHOR AB-4000 GOUGING TORCH PKG EA 1 253 .30 253.30
7FT. CABLE
Subtotal 253.30
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( Taxable amount: 10.00
CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT a 297.74
3400 W 131ST ST INVOICE: 00878987 INCLUDING TAX.
CARMEL IN 46074 INVOICEDATE: 01/18/13
ORDER: 01731.496-00 P/O: VERBAL: MIKE HENRICKS
INDIANA OXYGEN COMPANY e 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))
01/14/13 00878987 $297.74
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.
ALLOWED 20
Indiana Oxygen
IN SUM OF $
P. O. Box 78588
Indianapolis, IN 46278-0588
$297.74
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 1 00878987 1 42-311.001 $297.74 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
Friday, January 25, 2013
Street`Commissioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
INV ITEA! INVOICE DATE - -!NV(1rF BEGINNING SHIPPED RFr1JRNED1 FNZN� LEASED CYLINDER EXTENDED
ryP BAL-1. . BAUDAYS
RATE AMOINT
R SHP SMALL HIGH PRESSURE 1 0 01
0 31 .339 10. 51
PurChass
Dpscriptbn
P.O.#
�rn C C)
11 or F
G.L.#— 422 go/,
Budget
Line Des er
Purchase Date
,-- ,-,-7
I
Approval
Data
—T—
TAX: .00
CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL ® 10.51
1411 E. 116TH ST. INVOICE: 0 821.9 0,112
CARMEL IN 46032 INVOICE DATE: 12/31/ 12
TOTAL CYL VALUE: 10 0 . 'r)C P/O:
INDIANA OXYGEN COMPANY P.O. BOX 78588• INDIANAPOLIS, IN • 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
12/31112 8219042 Rental of oxygen tanks Dec'12 $ 10.51
Total $ 10.51
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.
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 8219042 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
24-Jan 2013
T
Signature
$ 10.51 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund