HomeMy WebLinkAbout260115 06/28/16 1°t_C4Nb
`/ � CITY OF CARMEL, INDIANA VENDOR: 359584
Y,; ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $*******735.00*
s. a CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK NUMBER: 260115
9''zsaN CHICAGO IL 60686 CHECK DATE: 06/28/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 BMS384725 735.00 OTHER EXPENSES
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 MID-SOUTH INC Purchase Order No.
3796 RELIABLE PARKWAY Terms
CHICAGO, IL 60686-0037 Due Date 6/9/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/9/2016 384725 $735.00
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
BRENNTAG
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
INVOICE#: BMS384725 INV DATE: 6/07/16 ** PAGE 1 OF 1 **
DUE DATE: 7/07/16
SOLD TO: SHIP TO:
CARMEL WATER CARMEL UTILITIES PLT 1
3450 WEST 131ST STREET 4915 E 106 ST
CARMEL IN 46074 CARMEL IN 46033
FEDERAL ID #: 610504545 DATE SHIPPED: 6/07/16 TERMS NET 30 DAYS
B/L #. . . : 1424623-00 SHIP WHS : 29 SALESPRSN: 299
CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG
CUSTOMER PO#: VERBAL FOB . . : DELIVERED
FRGT COMMENT: PREPAID TAX EX# : 356000972-001-9
PRO NUMBER . : 635589443
UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED
---------------------------------------------------------------------------------
1 .0000 253418 11 .87000 2000 .0000# .3500 700.00
2000.0000 # CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
--------------------------------------------------------------------------------
QUESTIONS, CALL 317-898-8632
* REMIT TO ADDRESS :
* BRENNTAG MID-SOUTH, INC
* 3796 RELIABLE PARKWAY
* CHICAGO IL 60686-0037 MERCHANDISE 700.00
INS & SEC SURCHARGE 35.00
-----------------
PAID ON OR PRIOR TO 7/07/16 INVOICE TOTAL USD 735.00
PAID AFTER 7/07/16 INVOICE TOTAL USD 749. 70
Original Document
E .:Ll of 1..acn.nq/Sh1.pmmn>t t PCel.p°t, *>K* Contint.ed from PrPv:%at.l,S Page Page 2 of 2 , -
PRFNNTAG MID-SOUTH PHONE: 317-898-8632 -17+/-6
3111 N POST RD FAX_-
® �
DEA REG NO- 006601BNY �,,. ; ;,, B R�N N•,1�
INDIANAPOLIS, IN . 6226
1,424623-00 Del.v Date- 6/07/16
Ship CARMEL UTILITIES PLT 1 Sold CARMEL WATER Cwcftomer: /+•07542 Ship To: 11 Ship Date: 6/07/16 0 Sh'ir
To: 491.5 E 106 ,8T To: 1450 WEST 1.31.ST STREET Att:n- Frt Terms: PREPAID Frt
CARMEL., IN 46023 CARMEL, IN 4607.4• j FOB_ - - : DELIVERED
Taken By : f3M29D1_C Sl.
Ship Via- OUR TRUCK - PKG, Placed By: WILLIAM BELL.
Rec:v Wrs- 8:00 AM® .4:00 PM Phonm#_ 31.7-571-24-42
Phone: 31.7-571 .2443 Ext- Phone: 117-A>571-24.4-3 EX`h Terms_ _ : NET 30 DAYSCU9t Pt7xl : VERBAL
QUANTITY
SHIPPED PACKAGING HM DESCRIPTION I M ORDERED QUANTITYPRODUCT CONTj
BACKORDERED CODE DEP(
IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: 4 .
CCN3170 EMERGENCY CONTACT: .CALL CHEM C TOLL. FREE AT I.-J80-.42419300"
- 24 HOURS / 7 DAYS Received
I
1 R ' lJN1.01.7, bate :
CHLORINE, P 0 #
2.1,(5.1.),(8)
}
RQ,MARINE_P0l_LUTANT ACCT # : � f
I PO.T.SON-.TNHAL.ATI:ON HAZARD, ;PONE RUse :
P�cn� Gl
! CHLORINE
1_0000 2000-0000 LB CYL CHO-RINE, LIQUID (:SMS ;ONLY). >A RPl4 x_0000
L.00: OSEaS ,
Pr odtt t. picked from,--
Lot-
from:Lot- 2 . l..or.: OSEO5! Qty: 1.00.00
i Freight Cl.zaur._ - - - 200
!
! Weight Pet- Gallon: 11._ 37000 Net. Weight,:; 2000.000 !CVL
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Ne' W-ti.-h�..�.�,a- x,2,000----:1.- --:,rte--- !�t7t a
:a�
,
This is to certify that the above named materials are properly classified,described,packaged,marked,and labeled,and are in proper
condition for transportation according to the applicable regulations of the Department of Transportation. Loaded :Sy: N
Checked :3y
Signature of Shipper c '% c. 'c .rte j Vehicle- Driver- ,,,,,, .,,,,
PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE i M11 ps.=1111111.1-11- Time In T
:,,.,,,,,,,,.,,,.,,,,. ,,,........
BY THE PURCHASER OF ALL TERMS AND CONDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF. -Wood Pal.1.efts. Dl.V dPallets
MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S). / P as,�,i O P4, 1 � D U .... , P ,1 P R „,,,,,,,,,,,,,,
Wood R�tn:
„ it~ a1.. s n:
Received by: Date: '
CUSTOMER COPY
i .