228933 2/11/2014 CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC
CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK AMOUNT: $575.00
CHICAGO IL 60686
CHECK NUMBER: 228933
CHECK DATE: 2/11/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BMS639586 575 . 00 OTHER EXPENSES
BRENNTAG
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
INVOICE#: BMS639586 INV DATE: 1/17/14 *** PAGE 1 OF 1 ***
DUE DATE: 2/16/14
SOLD TO: SHIP TO:
CARMEL WASTE WATER HAZEL DELL
3450 WEST 131ST STREET 9609 HAZEL DELL
CARMEL IN 46074 CARMEL IN 46280
FEDERAL ID #: 610504545 DATE SHIPPED: 1/17/14 TERMS NET 30 DAYS
B/L #. . 542531-00 SHIP WHS : 29 SALESPRSN: 294
CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG
CUSTOMER PO#: 513836 FOB . . : DELIVERED
TAX EX# : 356000972-001-9
UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED
--------------------------------------------------------------------------------
1 . 0000 253418 11 . 870 2000 .0000# .2700 540 .00
2000 . 0000 # CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
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QUESTIONS, CALL 317-898-8632
* REMIT TO ADDRESS:
* BRENNTAG MID-SOUTH, INC
* 3796 RELIABLE PARKWAY
* CHICAGO IL 60686-0037 * MERCHANDISE 540 .00
INS & SEC SURCHARGE 35 .00
-----------------
PAID ON OR PRIOR TO 2/16/14 INVOICE TOTAL USD 575 .00
PAID AFTER 2/16/14 INVOICE TOTAL USD 586 . 50
Original Document
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VOUCHER # 137366 WARRANT # ALLOWED
359584 ' IN SUM OF $
BRENNTAG_P—L-RIGH)
3796 Reliable Parkway
CHICAGO, IL 60686 4
fl
Carmel Wastewater Utility
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ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT I Audit Trail Code
BMS639586 01-7182-05 $575.00
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1
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y
Voucher Total $575.00
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
359584
BRENNTAG (ULRICH) Purchase Order No.
3796 Reliable Parkway Terms
CHICAGO, IL 60686 Due Date 2/6/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/6/2014 BMS639586 $575.00
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