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227401 12/17/2013 CITY OF CARMEL, INDIANA VENDOR: 154252 Page 1 of 1 ONE CIVIC SQUARE INDIANA OXYGEN CO CARMEL, INDIANA 46032 PO BOX 78588 CHECK AMOUNT: $377.59 INDIANAPOLIS IN 46278 CHECK NUMBER: 227401 CHECK DATE: 12117/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 01085051 183 . 58 MATERIALS & SUPPLIES 854 5023990 01905126-00 183 . 54 ARTS DIST FESTIVAL 1094 4239012 08265056 10 . 47 SAFETY SUPPLIES SHIP'D _sio PRICE AMOUNT ** Location: A ** AC 144 0 0 0 1 COMPRESSED GASES, N.O.S. , 2.2 CYL 41.278 0.00 UN1956 OCF @ ** N/A ** (75% ARGON 25% CARBON DIOXIDE) AC 75/25 1 0 1 0 ARGON,CARBON DIOXIDE 75/25 384CF CYL 70.516 70.52 INDUSTRIAL GAS MIX CGA580 384CF @ 18.3635/100CF KISKC2803544 44 0 7056 .035 X 44# SPL LB 1.82 80.08 70S6035X44 #SPOOL FSCFUEL SURCHRG 1 0 TEMP DIESEL SURCHARGE OUR TRUCK EA 5.05 5.05 HMCHAZ MAT CHG 1 0 HAZARDOUS MATERIAL CHARGE EA 4.95 4.95 Subtotal 160.60 TOTAL CYLIN ERS SHIPPED: 1 RETURNED: 1 visit us on facebook or on the Delivery Charge 22.98 we at www.indianaox gen.1om Taxable amount: 0.00 CARMEL WATER CUSTOMER: 12598 AMOUNT 183.58 THIS INVOICE 3450 W 131ST ST INVOICE: 01085051 INCLUDING TAX CARMEL IN 46074-8267 INVOICEDATE: 12/09/13 ORDER: 01905646-00 P/O: INDIANA OXYGEN COMPANY • P.O. BOX 78588• INDIANAPOLIS, IN 46278-0588 VOUCHER # 133640 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 01085051 01-6200-06 $183.58 i I Voucher Total $183.58 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 12/12/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/12/201, 01085051 $183.58 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 >"Z//L 113 Date Officer i _ ____ _ _____ _ INV INVOICE DATE INVOICE- - -BEGINNING-. .SHIPPED--9ETU9NED ENDING ._.LEASED___.g�L/nnyg _ CYLINDER EXTENDED- TYPE BALANCE "' BALANCE CYLINDERS RATE AMOUNT R SHP SMALL HIGH PRESSURE 1 0 0 1 0 30 .349 10.47 Oxy0al f r Nail'13 c)op Lf LP23 2 TAX: .00 CARMEL CLAY PARKS CUSTOMER: 03390 TOTAL ® 10.47 1411 E. 116TH ST. INVOICE: 08265056 CARMEL IN 46032 INVOICEDATE: 11/30/13 TOTAL CYL VALUE: 100.00 Plo: INDIANA OXYGEN COMPANY v P.O. BOX 78588• INDIANAPOLIS, IN • 46278-0588 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 154252 Indiana Oxygen Company Terms P.O. Box 78588 Indianapolis, IN 46278-0588 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 11/30/13 8265056 Rental of Oxygen tanks Nov'13 36390 $ 10.47 Total $ 10.47 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 5-11-10-1.6 120 Clerk-Treasurer Voucher No. Warrant No. 154252 Indiana Oxygen Company Allowed 20 P.O. Box 78588 Indianapolis, IN 46278-0588 In Sum of$ $ 10.47 ON ACCOUNT OF APPROPRIATION FOR 109 -Monon Center PO#or Board Members Dept# INVOICE NO. CCT#/TITL AMOUNT 1094 8265056 4239012 $ 10.47 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 12-Dec 2013 $ 10.47 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund (E��1V`D�I77(t1��NA, ' 11ND11Ci1NA OXYGEN C®M11L"1'1NY, INC. �njnj �� M P.O. ]SOX 78588 O MWECN 11 r/ VOW ><NDLAI NAPOILIS, INDLANA 46278-0588 Bloomington 0 Cincinnati a Elkhart Fishers Indianapolis (812)330-9210 (513)353-2448 (574)295-4433 (317)841-0002 (317)290-0003 Lafayette 0 Marion 0 Muncie 0 Seymour 0 Vincennes (765)474-7095 (765)662-8700 (765)289-2373 (812)522-4421 (812)882-4323 { i America's Oldest GaslWelding Supply u��-' 174`'7`' CUSTOMER N 1 ORDER 019-0 5126-00`. I CARMEN, CITY OF 1,1 O W. MA I.N. Sl . STE. 220 ORDER DATE 12/06/13 I ._ CARMEL. IN 460 32 PAGE Cit i 1. OF 001, f u 317-571-277 a, . 'NAME CARMEL,"fITYi0F TERR 005 SHIP VIA Our Truck -NONE- INITIALS DNS P.O.# ¢"✓ SALES 000 SHIP CODE 00 UPS 0 ORDER TYPE CASH-COD REL# BRANCH 001 COUPPD PREPAID TIME 06-DEC-13 11:57AN PHONE# 317-571-2787 ROUTE# USERNAME dons QTY UNIT HM --------DESCRIPTION------------ ID LINE ------ITEM----- LOC QTY -CYLINDERS- VOLUME/ UNIT EXTENDED SHIP $ HAZARD CLASS- NUMBER NO NUMBER`:' : ORDER SHIP RETN WEIGHT AMOUNT = AMOUNT F --------°---------------------------------------------------------- -------------------------- -------- >t **** COD ORDER 1 CYL Helium, Compressed, 2.2, :1.1141046.-. 1 HE 200 A 1 1 200 150.5% 150.E 125.00 (HELIUM BALLOON GRADE 200CF), _-(CFA580-NOT FOR INDUSTRIAL''USE) - :.. • r -, _..- .. _ _. _._ PLEASE NOTE THAT THERE WILL BE A RENTAL CHARGE'OF $2.00 PER DAY AFTER 3 DAYS IF YOU DO NOT HAVE A HELIUM RENTAL CONTRACT 6dITH US. ------------ ------------------------------------------ --— -- -------- --------------------------------- ---- ------- --- ' QTY UNIT HM ---------DESCRIPTION°`--------— LINE -- ITEM-----,LOC eQTY QTY BIN WEIGHT UNIT EXTENDED SHIP & HAZARD CLASS NO NUMBER . ? `;:ORDER BKORD LOC AMOUNT AMOUNT 1 EA TEMP DIESEL SURCHARGE OUR TRUCK 2 FSC FUEL SURCIRG .' A 1 0 .00 5.05 . 5.05 1 EA HAZARDOUS MATERIAL CHARGE 3 HMC HAZ MAT CHG A 1 0 .00 4.95 4.95 WOULD LIKE TUESDAY 12-9-13 DELIVERY AFTER 12PM CALL STEPHANIE 496-9116 Total Weight: 125.0000 Subtotal 160.56 Tax .00 Freight 22.98 Total Sale 183.54' SPECIAL INSTRUCTIONS: 0 ACCEPTED REFUSED EMERGENCY RESPONSE TELEPHONE NUMBER: 8005 PLACARDS:355053 - Customer authorizes Seller to debit Custo©er's credit card or deduct from the TERMS&CONDITIONS t THE CUSTOMER HEREIN CONSENTS TO AND ACCEPTS THE ABOVE PRODUCTS Customer's deposit any outstanding balance retaining on the Customer's a o1ntSUBJECTTOALLOFTHECONDITIONSASSETFORTHONREVERSESIDEHEREOF _ ND THE EXISTING CONTRACT BqqVVEEN BOTH PARTIES. IMPORTANT I a . PLEASE READ CAREFULLY THE TERMS AND CONDITIONS OF SALE WHICH APPEAR RECEIV BY(SIGNATURE) DATE ON THE REVERSE SIDE OF THIS DOCUMENT. ALL SALES MADE ARE SUBJECT TO SUCH TERMS AND QoNbITIONS. CUSTOMER SIGNATURE HEREON VERIFIES X SHIPPED AND RETURNED RENTAL CYLINDER COUNT SHIPPED BY CUSTOMER VOUCHER NO. WARRANT NO. ALLOWED 20 Indiana Oxygen Company, Inc. IN SUM OF $ P. O. Box 78588 Indianapolis, IN 46278 $183.54 ON ACCOUNT OF APPROPRIATION FOR Community Relations Gift Fund 854 PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 854 I 01905126-00 $183.54 I _ I 1 hereby certify that the attached invoice(s), or .� bill(s) is (are) true and correct and that the a�S materials or services itemized thereon for which charge is made were ordered and received except Monday, December 16,2013 11" Y/�" Director, Community Relations/Economic Development 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)) 12/06/13 01905126-00 $183.54 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