227006 12/11/2013 �qF CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1
ONE CIVIC SQUARE INDIANA OXYGEN CO
CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $137.76
•_ INDIANAPOLIS IN 46278
CHECK NUMBER: 227006
CHECK DATE: 12/1112013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4231100 08265375 87 . 36 BOTTLED GAS
601 5023990 1081096 50 .40 OTHER EXPENSES
CYLINDER RENTAL INVOICE
INDIAN-A INDIANA OXYGEN COMPANY CUSTOMER:07851 PAGE: 1
P.O. BOX 78588 INVOICE: 08265375
INDIANAPOLIS, IN 46278-0588 INV DATE: 11/30/13
317-290-0003 SALESPERSON:0 0 O TERR: 007
BRANCH: 004
P/O:
TERMS: NET 3 0
B S
I CARMEL STREET DEPT H CARMEL STREET DEPT
� 3400 W 131ST ST P 3400 W 131ST ST
CARMEL IN 46074 CARMEL IN 46074
T T
0 O
INVOICE AMOUNT: 87-36]
---------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT----------------------------------------
INV YP' BALANCE BALANCE CYLINDERS ITEM- INVOICE DATE -INVOICE- BEGBEGINNING BEGINNING SHIPPED-RETURNED- ENDING- LEASED_ BAUDAYS CYLINDER EXTENDED
RATE AMOUNT
• ALY ACETYLENE 3 0 0 3 0 90 .389 35 . 01
• ARG ARGON 1 0 0 1 1 0 .349 .00
• CO2 CARBON DIOXIDE 1 0 0 1 0 30 .349 10.47
• MIX MIX GASES 2 0 0 2 0 60 .349 20.94
• OXY OXYGEN 2 0 0 2 0 60 .349 20.94
TAX: .00
CARMEL STREET DEPT CUSTOMER: 07851 TOTA=00.
87 .36
3400 W 131ST ST INVOICE: 08265375
CARMEL IN 46074 INVOICE DATE: 11/30/13
TOTAL CYL VALUE: 2700. 00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588
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. I ACCT#/TITLE I AMOUNT Board Members
2201 I 08265375 I 42-311.001 $87.36 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
Frid c 3
S�' mmisslonoe e
Title
Cost distribution ledger classification if
claim paid motor 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 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))
11/30/13 08265375 $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
------------------------------------------- PLEASE SEND TOP PORTION WITH YOUR PAYMENT--------------------------------------------
ITEM -or — — -DESCRIPTION — _:UONi'- - UNIT AMOUNT
SHIP'D aT PRICE
** Location: A **
AC 144 1 0 1 1 COMPRESSED GASES, N.O.S. , 2.2 CYL 41.278 41.28
UN1956
144CF @ 28.6653/1000F
(75% ARGON 25% CARBON DIOXIDE)
FSCFUEL SRCHGWC 1 0 TEMP DIESEL SURCHARGE W/C EA 4.17 4.17
HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 4.95 4.95
Subtotal 50.40
TOTAL CYLINDERS SHIPPED: 1 RETURNED: 1
Visit us on facebook or o the
web at www.indiInaoxygen. om
Taxable amount: 0.00
CARMEL WATER CUSTOMER: 12598 • • 50.40
3450 W 131ST ST INVOICE: 01081096
CARMEL IN 46074-8267 INVOICE DATE: 11/26/13
ORDER: 01901163-00 P/O:
INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588
VOUCHER # 133530 WARRANT # ALLOWED
i
154252 i IN SUM OF $
INDIANA OXYGEN CO
PO BOX 78588
INDIANAPOLIS, IN 46278 ,{
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
l
i Board members
PO# INV# ACCT# AMOUNT I Audit Trail Code
1
i
1081096 01-6200-06 $50.40
i
I
y
n
{
i
it
Voucher Total $50.40
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 12/5/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/5/2013 1081096 $50.40
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
Date Officer