216764 01/29/2013 a 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: $220.25
INDIANAPOLIS IN 46201
CHECK NUMBER: 216764
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4351501 56617 220 . 25 EQUIPMENT MAINT CONTR
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515
D-' JACOB DIETZ, INC.
FIRE PROTECTION SPECIALISTS I ZGS
130 South Ewing St. •
Indiana olis In V
P ,IN 46201 OlCe
317-631-2304 Fax 317-631-3117 Date
Invoice#
Bill To 12/31/2012 56617
City of Carmel Ship To:
One Civic Square Carmel City Building
Carmel, IN 46032
P.O.No. - – - _ — --- -- _
Work Order#
Terms Due Date
28608 Rep Project
Quantity 1213112012
Description Carmel City Building
19 Exting Fire
1 uisher annual inspection Rate
13#halon 1211 hydrotest Amount
1 5# CO2 Test&Recharge .3
2 5#ABC 6 year 42.35 57.00
1 2-1/2# Y maintenance 42.35
ABC Extinguisher condemned 23.00 23.00
1 2-112 #ABC Amerex 10.00
1 CO2 Neck o-ring 0.00 20.00
1 OR29 Neck o-ring 32.50 0.00
2 OR27 Neck o-ring 2.50 32.50
1 Amerex safety disc Q 1.30 2.50
D 1.30 1.30
1 Amerex stem 2 60
1 Badger stem JAN 2 8 2013 10.75 10 75
1 Kidde stem 6.00 6.00
1 Truck charge B 7.00 7.00
-- - -- _ y 5.25
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Pay online 0.00 5.25
e at: - --- —_ __-- 1.0.00
hops://ipn.intuit.com/sfjhwcmn _--_ - - -
—1-- --
Subtotal
$220.25
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
$220.25
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
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Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
12/31/12 56617 $220.25
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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
Jacob -Deitz, Inc.
IN SUM OF $
130 S. Ewing Street
Indianapolis, IN 46201
$220.25
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
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PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year
1205 56617 43-515.01 $220.25 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
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which charge is made were ordered and
received except
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Mond y, January 28, 2013
Director, A ministration
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Title
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Cost distribution ledger classification if
claim paid motor vehicle highway fund