224938 10/08/2013 *f CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $409.29
INDIANAPOLIS IN 46278
CHECK NUMBER: 224938
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01056615 29 . 21 OTHER EXPENSES
601 5023990 01059589 300 . 00 OTHER EXPENSES
601 5023990 01059591 80 . 08 OTHER EXPENSES
o v QTv UNIT AMGUNT ITEM SHiP'D aro uESCRI V
----- —--- - — PRICE
** Location: A **
KISKC2803544 44 0 70S6 .035 X 44# SPL 1,13 1.82 80.08
7056035X44 #SPOOL
Su
j btotal. 80.08
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Taxable amount: 10.00
CARMEL WATER CUSTOMER: 12598 AMOUNT a 80.08
THIS 3450 W 131ST ST INVOICE: 0105959-1
CARMEL IN 46074-8267 INVOICEDATE: 09/26/1-3 INCLUDING
ORDER: 01873989--00 P/O:
INDIANA OXYGEN COMPANY P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588
--------------------------------- --- rLrtAJCJOVU iUr run I'UINVVUn TUUnrr,TrviIZivi
I oITEM orr - ---I UGN UNIT
SHIPD sio DESCRIPT AMOUNT
PRICE
** Location:
NI 210 0 01 O 1 NITROGEN, COMPRESSED, 2 .2 CYL 19.305 0.00
UN1066
OCF @ ** N/A *'
** Location: A **
CD 50RBCC 1 0 1 1 CARBON DIOXIDE, COMPRESSED 2 .2 CYL ! 20.00 20.00
UN1013 (LIQUID WITHDRAWL)
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! 50CF @ 40.0000/7 000'!;'
** Location: iD **
FSCFUEL SRCHGWCI 1i 0, TEMP DIESEL SURCHARGE W/,- EA 4.26 4.26
HMCHAZ MAT CHG 1 : Oj HAZARDOUS MATERIAL C:HARGii] EA 4.95 4.95
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Subt:ota1 29.21
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TOTAL CYLINDERS SHIPPED: 1 RETURNIED: 2
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Taxable amount:] 0.00
CARMEL WATER CUSTOMER: 12598 AMOUNT 29.21
THIS INVOICE
3450 W 131ST ST INVOICE: 0105667.5
INCLUDINGTAX�.-
CARMEL IN 46074-8267 INVOICEDATE: 09/18/13
ORDER: 01870085--00 P/O:
INDIANA OXYGEN COMPANY e P.O. BOX 78588• INDIANAPOLIS, IN a 46278-0588
------------------------------------------- tLLAoIzbtNIJ I OF FOR IION WIIH YOUR F'AYMLNI ----
QTY QTY ITEM I DESCRIPTION UOtvl UNIT AMOUNT
' sRIPO f a/o - -- - — '— PRICE
** Location: A **
CYL220 1 0 220 CF CYL SOLD OUTRi.G!i'i' EA 280.00 280.00
CD 50RBCC 1 0 1 1 CARBON DIOX IDE, COMPIZ!_!Ss;,:;) 2 .2 CYL 20.00 20.00
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UN1013 (LIQUID WITHDRAWL)
50CF @ 40.000C/1.00CF
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Subrota]- 300.00
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TOTAL CYLINDERS SHIPPED: 1 RETUR.N :D:
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Taxable amount:) 0.00 1
CARMEL WATER CUSTOMER: 12598 300.00 THIS INVOICE
3450 W 131ST ST INVOICE: 01059589 INCLUDINGTAX--,
CARMEL IN 46074-8267 INVOICEDATE: 09/26/13
ORDER: 018 7398 -CO P/O: GH92613
INDIANA OXYGEN COMPANY e P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588
VOUCHER # 132962 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
01059589 01-6200-06 $300.00
11 -19.01
Voucher Total Ly t '�� $ 0
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
154252
INDIANA OXYGEN CO Purchase Order No.
PO BOX 78588 Terms
INDIANAPOLIS, IN 46278 Due Date 10/1/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/1/2013 01059589 $300.00
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
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Date Off cer