223525 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO CHECK AMOUNT: $127.89
CARMEL, INDIANA 46032 PO BOX 78588
INDIANAPOLIS IN 46278 CHECK NUMBER: 223525
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4232100 01041897 48 . 26 GARAGE & MOTOR SUPPIE
2201 4231100 01045290 79 . 63 BOTTLED GAS
ORIGINAL INVOICE
INDLXNA INDIANA OXYGEN COMPANY 17c-U-ST-O-M-E R:-0-7-85-1— PAGE: 1
P.O. BOX 78588 INVOICE: 01045290 i
I ORDER: 01855504-00
INDIANAPOLIS, IN 46278-0588 -INVDATE-. 08/16/13 ORD DATE: 08/16/13
317-290-0003 SALESPERSON: 000 ITERR: 007
BRANCH: 004 INT: DAB
P/O:-- SHOP
ITERMS: NET 30
SHIP VIA: Will Call
RELEASE#:
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
L 3400 W 131ST ST 1 P 3400 W 131ST ST
L
CARMEL IN 46074 CARMEL IN 46074
T T
0 0
INVOICE AMOUNT: 79.
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT------------------------------------------
ITEM-- -oTy OTY DESCRIPTION UOm UNIT AMOUNT
SHIP'D B10 PRICE I
Location: D
AC 75/25 1 0 1 1 ARGON,CARBON DIOXIDE 75/25 384CF: CYL 70.516 70.52
INDUSTRIAL GAS MIX CGA580
384CF @ 18.3635/10001;
FSCFUEL SRCHGWCI I 0� TEMP DIESEL SURCHARGE W/C EA 4.16 4.16
HMCHAZ MAT CHG j 1 Oj i HAZARDOUS MATERIAL CHARGE EA 4.95 4.95
h) o tt a 1. 79.63
TOTAL CYLINDERS SHIPPED: 1 RETURNED: I
I II
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Web at www.indianaoxygen. ::om
Taxable amount:] 10.00
CARMEL STREET DEPT CUSTOMER: 07851 AMOUNT 79.63 1
THIS INVOICE
3400 W 131ST ST INVOICE: 01.045290 INCLUDING T'AX
CARMEL IN 46074 INVOICEDATE: 08/16/13
ORDER: 01855504-00 P/O: SHOP
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588
ORIGINAL INVOICE
INDIAN2x INDIANA OXYGEN COMPANY -CUSTOMER: 07851 PAGE: 1
P.O.BOX 78588 INVOICE: 01041.897 ORDER: 018 0=5 10
65-OO
INDIANAPOLIS,IN 46278-0588 INV DATE:—08/0'7/13 JORDDATE: 08/07/13
317-290-0003 SALESPERSON: 000 TERR: 007
BRANCH: INT: DAB
P/O* SHOP
TERMS: _N1_-',_T_3 0
-SHIP VIA: Will Call
RELEASE#:
B S
I CARMEL STREET DEPT H 'A!�ME!, STI�EET DEPT
L 3400 W 131ST ST 3400 W 131ST ST
L CARMEL IN 46074 -ijj 46074
T T
0 0
INVOICE AMOUNT: 48.26
------------------------------------------ PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
I OTY UNIT
ITEM DESCRIPTION UOM PRICE AMOUNT
SHIFID (')T/oy
Location: D
TWEGC300 1 0 GC300 300AMP COPPER CH. CLAMP EA I 48.26 48.26
Subtotal. 48.26
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Taxable amount:, 10.00
CARMEL STREET DEPT CUSTOMER: 078131 48.26
3400 w 131ST ST INVOICE: 01.041897
MCI_
CARMEL IN 46074 INVOICE DATE: 08/0'1/1.3
ORDER: 01-85106-)- 00 P/O: SHOP
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))
08/07/13 01041897 $48.26
08/16/13 01045290 $79.63
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
$127.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
2201 01041897 42-321.00 $48.26 1 hereby certify that the attached invoice(s), or
2201 01045290 42-311.00 $79.63 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
day gust 23, 2013
uautdl
Street Commi i er
Street 'Psioner
o
Cost distribution ledger classification if
claim paid motor vehicle highway fund