252789 12/15/15 ,C_IH .
`t*'�.. 0"�' CITY OF CARMEL, INDIANA VENDOR: 368696
;, ® `i1 ONE CIVIC SQUARE SOLENIS LLC CHECK AMOUNT: $****23,816.00*
CARMEL, INDIANA 46032 PO BOX 116232 CHECK NUMBER: 252789
2.{,,TON�` ATLANTA GA 30368-6232 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 131013742 23,816.00 OTHER EXPENSES
s�smenis INVOICE ORIGINAL
Page 1(1)
Invoice Number Invoice Date [Due Date
0 131013742 02 Dec 2015 1an 2016
®N
®� Solenis LLC P.O.Number Payment Terms Payer Number
M 3 Beaver Valley Road s15628 Net 30 Days 441113
c Suite 500
Wilmington DE 19803 Shipped From Sales Order Num Bill-To Number
USA US GREENSBORO DOYLE ST PL PK 7320667 441113
Remittance instructions below Bill of Lading NumberIncoterms:DAP Dest Prepaid Ship-To Number
1000094767 442287
Billing address Shipping address
CITY OF CARMEL CITY OF CARMEL
WATER-WASTEWATER UTILITIES WATER-WASTEWATER UTILITIES
9609 HAZEL DELL PKWY 9609 HAZEL DELL PKWY
INDIANAPOLIS IN 46280 INDIANAPOLIS IN 46280
Qty. UoM Material Number Material Description Batch Billing Qty UoM Unit Price Amount
Number USD
6 IBC 657240 PRAESTOL K 274 FLX IBC 1000L 1511522 18,320 LB 1.3000 23,816.00
01.'7 I$'P.OS
Should you have any questions regarding this Invoice Total
invoice,please contact USD 23,816.00
NANCY SANDS
at 866-293-8897
Remit to ACH Credit Wire transfer
P.O.Box 116232 Solenis LLC Solenis LLC
ATLANTA GA 30368.6232 Account Number:71522253 Account Number.30960491
Clearing House Payments Co L.L Citibank NA
Bank-ID:021052053 Bank-ID:021000089
Please refer to the invoice number on the remittance.
Please return remittance advice with your payment. Off SoLen'S
Comments- 1
Federal ID number 46-5612095 D-U-N-S number 07-943-6434
The terms and conditions of this sale are set forth at http://www.solenis.com/
Print date 03 Dec 2015
visit us at www.solenis.com
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
358405
SOLENIS Purchase Order No.
PO BOX 116232 Terms
Atlanta, GA 30368-6232 Due Date 12/9/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/9/2015 131013742 $23,816.00
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
VOUCHER # 156837 WARRANT # ALLOWED
358405 IN SUM OF $
SOLENIS
PO BOX 116232
Atlanta, GA 30368-6232
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
131013742 01-7182-05 $23,816.00
Voucher Total $23,816.00
Cost distribution ledger classification if
claim paid under vehicle highway fund