220196 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
` ONE CIVIC SQUARE INDIANA OXYGEN CO
(t CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $108.30
«ox
r INDIANAPOLIS IN 46278 CHECK NUMBER: 220196
CHECK DATE: 5121/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1094 4239012 08235557 10 .47 SAFETY SUPPLIES
2201 4231100 08235884 87 . 36 BOTTLED GAS
601 5023990 08236266 10 .47 OTHER EXPENSES
INV ITEM INVOICE DATE INVOICE - BEGINNING SHIPPED RETURNED ENDING LEASED BAUDAYS CYLINDER EXTENDED
yp BALANCE RAI ANCE CYI.INDERS. - _ RATE AMOUNT
R SHP SMALL HIGH PRESSURE 1 0 0 1 0 30 .349 10.47
AY 0 7 2013
Purchase Y
Description
P.O.# or F 1
G.L.#
Budget
Line Descr
Purchaser Date
Approval Date
TAX: .00
CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL ® 10.47
1411 E. 116TH ST. INVOICE: 08235557
CARMEL IN 46032 INVOICEDATE: 04/30/1.3
TOTAL CYL VALUE: 100. 00 P/O:
INDIANA OXYGEN COMPANY 9 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
4/30/13 8235557 Rental of oxygen tanks Apr'13 $ 10.47
Total $ 10.47
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$
$ 10.47
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1094 8235557 4239012 $ 10.47 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
16-May 2013
7 III
Signature
$ 10.47 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
ENV ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED ENDING LEASED gAUDAYS CYLINDER EXTENDED
..AS.NCE _--- P.ALANDF., CVI.INDFRS RATE AMOUNT
R ALY ACETYLENE 1 0 0 1 1 0 .389 . 00
R MIX MIX GASES 1 0 0 1 1 0 .349 . 00
R NIT NITROGEN 1 0 0 1. 0 30 .349 10.47
R OXY OXYGEN 1 0 0 1. 1 0 .349 . 00
R SHP SMALL HIGH PRESSURE 1- 0 0 1 - 0 0 .349 . 00
I
{ i
1
--- ---- TAX: .00
CARMEL WATER CUSTOMER: 12598 TOTAL ® 10.47
3450 W 131ST ST INVOICE: 08236266
CARMEL IN 46074-8267 INVOICEDATE: 04/30/13
TOTAL CYL VALUE: 1200 . 00 P/O:
INDIANA.OXYGEN COMPANY • P.O. BOX 78588 9 INDI'ANAPOLIS, IN 9 46278-0588
--------; ;
131556 WARRANT # ALLOWED y
Prescribed b State Board of Accounts Cit y Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
w IN SUM OF $ I CITY OF CARMEL
GEN CO
a `
8 An invoice or bill to be properly itemized must show, kind of service, where
, IS, IN 46278 i performed, dates of service rendered, by whom, rates per day, number of units,
w' price per unit, etc.
el Water Utility Payee
154252
T OF APPROPRIATION FOR I INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 Due Date 5/11/2013
i
Board members
Invoice Invoice Description
# ACCT# AMOUNT Audit Trail Code ! Date Number (or note attached invoice(s) or bill(s)) Amount
I
5/11/2013 08236266 $10.47
66 01-6360-03
$10.47
sue_,
�4 1
d-
I Y
Voucher Total $10.47
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
ribution ledger classification if
correct and I have audited same in accordance with IC 5-11-10-1.6
d under vehicle highway fund s�7//j
Date Officer
CYLINDER RENTAL INVOICE
IN f)J-AMk INDIANA OXYGEN COMPANY CUSTOMER:07 8 51 PAGE: 1
P.O. BOX 78588 INVOICE: 08235884
INDIANAPOLIS, IN 46278-0588 INV DATE: 04/30/13
317-290-0003 SALESPERSON:0 0 0 TERR: 007
BRANCH: 004
P/O: _
TERMS: NET 3 0
B CARMEL STREET DEPT H CARMEL STNEEIT DEPT
�
3400 W 131ST ST P 3400 W 1-31ST ST
CARMEL IN 46074 CARMEL TN 46074
T T
0 0
INVOICE AMOUNT: 87 .36
---------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
INV ITEM I":`.'O!CE DATE I'dVOICE BEGINNING SHIPPED RETURt`!ED ENDING LEASED B^i�D4YS CYLINDER EXTENDED
TYPE BALANCE BALANCE CYLINDEHS RATE AMOUNT
• ALY ACETYLENE 3 0 0 3 0 90 .389 35. 01
• ARG ARGON 2 0 0 2 1 30 .349 10.47
• CO2 CARBON DIOXIDE 1 0 0 1 0 30 .349 10.47
• MIX 'MIX GASES 1 0 0 1 0 30 .349 10.47
• OXY OXYGEN 2 0 0 2 0 60 .349 20. 94
_ TAX: . 00
CARMEL STREET DEPT CUSTOMER: 07851 TOTAL ® 87 .36
3400 W 131ST ST INVOICE: 08235884
CARMEL IN 46074 INVOICEDATE: 04/30/13
TOTAL CYL VALUE: 2700 . 0 0 P/O:
INDIANA OXYGEN COMPANY • P.O. PDX 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))
04/30/13 08235884 $87.36
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.
ALLOWED 20
Indiana Oxygen
IN SUM OF $
P. O. Box 78588
Indianapolis, IN 46278-0588
$87.36
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUN i Board Members
2201 I 08235884 I 42-311.001 $87.36 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
)A All /f A e�14
F Ma 17, 2013
Str&EftoolgrTOM&ner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund