218114 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00351351 Page 1 of 1
ONE CIVIC SQUARE JACOB-DIETZ, INC CHECK AMOUNT: $108.00
CARMEL, INDIANA 46032 130 S EWING ST
`o INDIANAPOLIS IN 46201 CHECK NUMBER: 218114
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 8490 108 . 00 OTHER EXPENSES
JDJACINC. Invoice
OB-DETZ,
PROTECTION SPECIALISTS
130 South Ewing St. Date Invoice#
Indianapolis,IN 46201
317-631-2304 Fax 317-631-3117 11/30/2012 8490
Bill To: Ship To:
Carmel Utilities City of Carmel HHW
760 3rd Avenue SW 901 Rangeline Road
Carmel, IN 46032 Carmel, IN 46032
�I, -7 3bl-�. �
P.O.No. Work Order# Terms Due Date Rep Project
25214 11/30/2012 Carmel Utilities
Quantity Description Rate Amount
1 Semi-annual inspection of dry chemical Fire Protection system for 90.00 90.00
HHW trailer
2 Quick Response Fusible Link 212 degree 9.00 18.00
DUE
Subtotal $108.00 '
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 $108.00
pa�l�'f1199(MM is Dane
VOUCHER # 135046 WARRANT # ALLOWED
351351 IN SUM OF $
JACOB-DIETZ, INC.
130 S. EWING STREET
Indianapolis, IN 46201 1
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
i
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
8490 01-736H-08 $108.00
i
Voucher Total $108.00
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
351351
JACOB-DIETZ, INC. Purchase Order No.
130 S. EWING STREET Terms
Indianapolis, IN 46201 Due Date 3/6/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/6/2013 8490 $108.00
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
Al
Date Officer