221098 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
' CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $129.12
+° INDIANAPOLIS IN 46278 CHECK NUMBER: 221098
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 01020014 28 . 02 BOTTLED GAS
2201 4231100 08240090 90 . 28 BOTTLED GAS
601 5023990 12598 10 . 82 OTHER EXPENSES
ORIGINAL INVOICE
INDI11Ni1 INDIANA OXYGEN COMPANY CUSTOMER: 07851 I PAGE: 1
P.O.BOX 78588 INVOICE:_ 01020014 ORDER: 01795398-00
INDIANAPOLIS,IN 46278-0588 INV DATE: 06/04/13 ORD DATE: 06/04/13
317-290-0003 SALESPERSON: 000 TERR: 007
BRANCH: 004 INT: DAB
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SHOP
-TERMS-:.--- NET 3 0
SHIP VIA: Will Call
RELEASE#:
B
I CARMEL STREET DEPT H CARMEL STREET DEPT
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3400 W 131ST ST P 3400 W 131ST ST
CARMEL IN 46074 CARMEL IN 46074
T T
O O
INVOICE AMOUNT: 28.02
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
ITEM SKID Qn DESCRIPTION UOM UNIT AMOUNT
. D ao PRICE
j ** Location: **
AL MC 1 0 1 1 ACETYLENE 10CF CYL 23.073 23.07
CGA-200
10CF @ 230.7300/1-000F
IHMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 4.95 4.95
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j Subtotal 28.02
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 1 .
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( Taxable amount: 0.00
CARMEL STREET DEPT CUSTOMER: 07851 • 0 28.02
3400 W 131ST ST INVOICE: 01020014
CARMEL IN 46074 INVOICEDATE: 06/04/13
ORDER: 01795398-00 P/O: SHOP
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
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jN-JJLkN,A INDIANA OXYGEN COMPANY CUSTOMER:o'7'---8-5-1-- 1 PAGE: 1
P.O. BOX 78588 INVOICE: 08240090
INDIANAPOLIS, IN 46278-0588 INVDATE: 05/31/13 -�—TERR: 007
317-290-0003 SALESPERSON:0 0 0
BRANCH:-- 004
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TERMS:_ NP'-P 3-0-.---
B S
I CARMEL STREET DEPT H CARME], DEPT
L 3400 W 131ST ST 1 3400 W 1311ST ST
L P
CARMEL IN 46074 CARMf--;!, jN 1160'74
T T
0 0
INVOICE AMOUNT: 90.28
---------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
INV ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED, ENDING t EASED 13A!JDAY-', CYLINDER EXTENDED
PE BALANCE RAI __C� I�Yli C) RArE AMOUNT
R ALY ACETYLENE 3 0 0 3 0 93 .389 36 .18
R ARG ARGON 2 0 0 2 1 31 .349 10. 82
R CO2 CARBON DIOXIDE 1 0 0 1 0 31 .349 10.82
R MIX MIX GASES 1 0 0 1 0 31 .349 1.0.82
R OXY OXYGEN 2 0 0 2 O� 62 .349 21. 64
TAX: .00
CARMEL STREET DEPT CUSTOMER: 07851 90.28
3400 w 131ST ST INVOICE: 08240090
CARMEL IN 46074 INVOICE DATE: 05/31 /1 3
TOTAL CYL VALUE: 2700. 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 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))
05/31/13 08240090 $90.28
06/04/13 01020014 $28.02
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
$118.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 08240090 42-311.00 $90.28 1 hereby certify that the attached invoice(s), or
2201 01020014 42-311.00 $28.02 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
F y u 2013
StreWV66 git ner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Wv ITEM INVOICE DATE INVOICE BEGINNING SHIPPED RETURNED ENDING LEASED BAL/DAYS CYLINDER EXTENDED
p .?Al'ANr:F RAI ANCF r.Yl INnFRC RATE. AMOUNT
R ALY ACETYLENE 1 0 0' 1 1 0 .389 .00
R MIX MIX GASES 1 1 1 1 1 0 .349 .00
R NIT NITROGEN 1 0 0 1 1 0 31 .349 10.82
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
_ TAX: .00
CARMEL WATER CUSTOMER: 12598 TOTAL ® 10.82
3450 W 131ST ST INVOICE: 08240474
CARMEL IN 46074-8267 INVOICEDATE: 05/31/13
TOTAL CYL VALUE: 1200. 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 6/10/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/2013 12598 $10.82
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
-/i////
Date fficer
VOUCHER # 131798 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
i
12598 01-6360-03 $10.82
i
Voucher Total $10.82
Cost distribution ledger classification if
claim paid under vehicle highway fund