223824 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 367107 Page 1 of 1
ONE CIVIC SQUARE ALGALCO LLC
€ CHECK AMOUNT: $39.24
CARMEL, INDIANA 46032 PO BOX 502768
INDIANAPOLIS IN 46250 CHECK NUMBER: 223824
CHECK DATE: 9110/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 26336 104 39 . 24 DISC GOLF PROJECT-HAZ
Al•Gal;Cg - .
AIGaICo LLC DATE: September 1, 2013
Hydrogen on Tap TM INVOICE# 104
FOR: Hydrogen Delivery-P.O.#26336
P.O. Box 502768
Indianapolis, IN 46250 BILL TO: Attn: Dave Huffman
Phone: 317.361.2787 Carmel Street Department
Fax:317.576.6406 3400 W 131st Street
Westfield, IN 46074
Phone: 317.733.2001
DESCRIPTION ;AMOUNT
7000 liters of hydrogen, Cost=$39.24/per month $ 39.24
August 1 -August 31, 2013
SUBTOTAL $ 3.9.24
Terms: Net 30-days.
Make all checks payable to AIGalCo TAX RATE 0.00%
If you have any questions concerning this invoice, contact: _ - -
Kim Morris SALES TAX -
AIGalCo Business Development - ---- — -- -
kmorrs @algalcoonline.com -or-317.340.0211. OTHER -
THANK YOU FOR YOUR BUSINESS! TOTAL $ 39.24
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))
09/01/13 104 $39.24
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
AIGalCo, LLC
IN SUM OF $
P.O. Box 502768
Indianapolis, IN 46250
$39.24
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26336 I 104 I 42-311.001 $39.24 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
F/ y, ember 06, 2013
Stre rES imissionerr
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund