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Home My WebLink About301799 08/08/16 I CITY OF CARMEL, INDIANA VENDOR: 367211 ® ONE CIVIC SQUARE WATER SOLUTIONS UNLIMITED INC CHECK AMOUNT: $*****4,787.00* x a'. CARMEL, INDIANA 46032 PO Box 347 CHECK NUMBER: 301799 9MiroN.�o FRA NKLIN IN 46131 CHECK DATE: 08/08/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 39421 4,787.00 OTHER EXPENSES II i VOUCHER # 162239 WARRANT # ALLOWED 367211 IN SUM OF $ WATER SOLUTIONS UNLIMITED INC PO BOX 347 FRANKLIN, IN 46131-0347 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 39421 01-6180-03 4,787.00 /` Voucher Total 4,787.00 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 367211 WATER SOLUTIONS UNLIMITED INC Purchase Order No. PO BOX 347 Terms FRANKLIN, IN 46131-0347 Due Date 8/1/2016 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/1/2016 39421 4,787.00 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 WATER SOLUTIONS I N'VR 'v 0 1 C E MUIVLIMITEI) P. O. Box 347 Invoice Number: 39421 295 Industrial Drive Invoice Date: Jul 29,2016 Franklin, IN 46131 Page: 1 Voice: (317)736-6868 Fax: (317) 736-4322 Bill To: Ship to: CARMEL UTILITIES CARMEL UTILITIES 3450W. 131ST STREET 4915 E. 106TH ST. CARMEL, IN 46074 PLANT 1 USA CARMEL, IN 46033 USA CustomeriD WSU Delivery Receipt No. _ Payment Terms CARMEL--- DR149221-- -- - —Net 30-Days - - - --- Sales Rep ID, Shipping Method Ship Date Due Date DH DAVID HARVEY WSU-FR 7/28/16 8/28/16 Quantity Item Description Unit Price Amount 2,200.00 FLUORIDE LBS, SODIUM FLUORIDE 50#BAG 1.08 2,376.00 PLANT 1 2,200.00 FLUORIDE LBS, SODIUM FLUORIDE 50#BAG 1.08 2,376.00 PLANT 5 1.00 DELIVERY CHG 35.00 35.00 I Subtotal 4,787.00 Sales Tax Subtotal Invoice Amount 4,787.00 Check/Credit Memo No: FreightAmount TOTAL - Please remit payment to: Please include your invoice number on your check. Water Solutions Unlimited, Inc. P.O. Box 347 Franklin, IN 46131 WATER STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE. SOLUTIONS UNLIMITED FROM: WATER SOLUTIONS UNLIMITED SOLD TO: CARMEL UTILITIES FRANKLIN,IN USA CARMEL,IN 46074 USA 317-736-6868 www.getwsu.com 317-716-3909 US DOT HAZMAT REG NO.: 061015 550 014X SHIP TO: CARMEL UTILITIES JERRY CLOUD 4915 E.106TH ST. CARMEL IN 46033 CUSTID DELIVERY RECEIPT NO SALESID SHIP VIA PO NUMBER SHIP DATE DELIVERY DATE CARMEL 149221 DH DAVID HARVEY WSU 5934 7/28/2016 7/28/2016 QTY PACKAGING HM DESCRIPTION. NET WT(LB) GROSS WT(LB) CLASS SHIPPED 44 50 LB BAG RQ UN1690,SODIUM FLUORIDEjSOLID,6.1,III 2200 2200 44 50 LB BAG RQ UN1690,SODIUM FLUORIDE SOLID,6.1,III 2200 2200 i f e e f v.ei�• v- Date: U e - 16I GENERAL REMARKS: 2200 LBS TO PLANT 1;2200 LBS TO PLANT 5 For Chemical Emergency Spill,Leak,Fire,Exposure,or Accident,Call CHEMTREC Day or Night-Within USA and Canada: 1-800-424-9300 Subtotal(Weight subject to correction): 4400 4400 This is to certify that the above named materials are properly classified,packaged,marked,and labeled,and are in proper condition for transportation according to the applicable regulations of the DOT. NOTE:Where the rate is dependent on value,shippers are required to state specifically in writing the agreed or declared value of the property.The.agreed or declared value of the property is hereby specifically stated by the shipper to be not exceeding $ per COD REMIT TO ADDRESS: COD Amt: $ TOTAL CHARGES: FREIGHT CHARGES: COD FEE: Collect❑ $ Prepaid L3Collect❑ Prepaid I" RECEIVED,subject to Indvidually determined Win or contracts Nat have been agreed upon in willing between Ne tamer and slipper,If applicable,otherwise to the rates,clssvncations,and rufes that have been estabGstrd by the carder and am available to the shipper,on request,and to ao applicable state and rederal regulations.the Property described above in apparent goodorder,except a noted(indents and condition of contents of packages unk—),narked,consigned,and destined as Indicated bel—filch said company(Ire turd —pan, being understood IMoughwd this mnbap as rtreanmg any person or torpor tion in posseabn of as property under the contract)agree W carry delivery at sok datinagon,If on its route,or odrerwisa to deliver to another corder on the route to said desgratbn.It is mutually agreed as to each carder of all or any of said Property over all or any potion of said route to destination and a to each party at any time interested in an or any of said property that a ory service to be performed hereunder shelf be subject to an the conditions not prohibited by law,whether printed w wffiten herein contained,which are hereby agree to by the shipper and accepted far himself and his asegns. CUSTOMER'S AGENT SHIPPER'S AGENT PRINTED PRINTED NAME: - NAME: SIGNATURE: SIGNATURE: V02182015