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Home My WebLink About302524 08/31/16 CITY OF CARMEL, INDIANA VENDOR: 00351018 ONE CIVIC SQUARE ASPHALT MATERIALS INC CHECK AMOUNT: $**'*"•500.00' ?4 CARMEL, INDIANA 46032 PO Box 933022 CHECK NUMBER: 302524 F�'«u CLEVELAND OH 44193 CHECK DATE: 08/31/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4236300 8013129742 500.00 BITUMINOUS MATERIALS VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ASPHALT MATERIALS INC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER PO BOX 635474 IN SUM OF$ CITY OF CARMEL. An invoice or bill to be properly itemized must show:kind of service,where performed,dates service CINCINNATI, OH 45263-5474 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $500.00 Payee Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Street Department Terms Date Due PO# ACCT# DATE INVOICE# DESCRIPTION DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 8013129742 42-363.00 $500.00 1 hereby certify that the attached invoice(s),or 8/16/16 8013129742 $500.00 2201 201 2201 201 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 Tuesday,August 23,2016 Dave Huffman Director 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 20 Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Invoice Page 1 of 1 Invoice#: 8013129742 Invoice Date: 8/16/16 Customer PO: Asphalt Materials, Inc. Invoice Total: $500.00 Indianapolis,Indiana CITY OF CARMEL ONE CIVIC SQUARE CARMEL,IN 46032 Plant: Indianapolis For billing questions call: 317-228-8211 Ticket Ticket Description Quantity UoM Net Charge Comments' — --Date- 8/15/16 –Date-8/15/16 IN-25511 AE-90S 100.00 Gal $500.00 Customer Pick Up-5PL Material: $500.00 Services: $0.00 Freight: $0.00 Demurrage: $0.00 Tax: $0.00 Total: $500.00 Detach and include with remittance. Please remit 8013129742 P.O.Box 933022 Amount remitted Cleveland,OH 44193 CITY OF CARMEL Invoice date: 8/16/16 ONE CIVIC SQUARE Due date: 9/15/16 CARMEL,IN 46032 Customer Number: 200582 Customer PO: Payment terms: Net 30 Invoice Total: $500.00 2%per month will be charged if payment is not received by due date. Loading Permit Asphalt Materials, Inc. Indianapolis, IN Date: No 17 7 7 3 9 Customer's Name:_, f / re Product: Tank* Inches Gallon—s—1 Produ�1 Gallons/Ozs Additives Anti-strip Truck inspected before loading. [� Remarks: Loader Signature 24-HOUR EMERGENCY RESPONSE NUMBER:CHEMTREC 1-800-424-9300 Ticket Number:IN-25511 HERITAGE GROUP COMPANIES CCN#10435 FOR EMERGENCY RESPONSE INFORMATION,SEE DOT GUIDEBOOK GUIDE#27 NR,This product is not regulated as a hazardous material by the US DOT. DELIVERY TICKET Asphalt Materials Inc. 4902 W.86th Street Indianapolis,IN.46268• SOLD TO: CITY OF CARMEL(Cust#200582) SHIP TO: Customer Pick Up-5PL ONE CIVIC SQUARE CARMEL, IN 46032 PR0Ut�CT f 3$ w NET i ,€ TOI+IS , ` , NET GI*L1NS t °I~ AE-90S 821.801 0.41091 97.20 TANK SP>irCiFIC GRAVCiY PpCa f TLMP �D 010 172.0000 11.0131 1 8.4547250000 Aug 15 2016 10:41AM ET HAULER DR NER T12ACTOR# TRAILER TRUCK LAST CONTAINECI,;CONTAINER DETAILS,,; 0L __�_ .�- Randy 002 20(5PL) 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. This product meets AASHTO MP1 and was produced in accordance with the INDOT ASC program.This transport was inspected prior to loading and found acceptable for the material shipped in accordance with AASHTO PP26. Scalehouse Operator: ^ Lewis,Chris Driver certifies that the cargo tank supplied for this shipment is a proper container for the transportation of this commodity and that proper placards have been applied. Driver Signature: Customer Signature: EMULSIFIED ASPHALT WARNING--- May produce minor burns.on contactl 1. Hot emulsified asphalt may produce severe bums on contact to eyes or skin.Frequent or prolonged skin contact may cause irritation and dermatitis. 2. Stay upwind and vent container before unloading.Vapors and fumes may irritate the nasal and respiratory tracts.Extended exposure can cause dizziness and nausea. 3. Keep container away from heat,flame;sparks,or other sources of ignition.Do not pressurize,cut,weld,braze,solder,drill,or grind on this container, even if empty. --DO NOT TRANSFER TO UNLABELED CONTAINER-- Refer to the Safety Data Sheet for more detailed information and emergency first aid procedures. 24 Hour Emergency Number:CHEMTREC(800)424-9300 General SDS Assistance:1-317-875-4670 24-HOUR EMERGENCY RESPONSE NUMBER:CHEMTREC 1-800-424-9300 Ticket Number:IN-25511 HERITAGE GROUP COMPANIES CCN#10435 FOR EMERGENCY RESPONSE INFORMATION,SEE DOT GUIDEBOOK GUIDE#27 NR, This product is not regulated as a hazardous material by the US DOT. ~ DELIVERY TICKET Asphalt Materials Inc. 4902 W.86th Street Indianapolis,IN 46268 SOLD TO: CITY OF CARMEL(Cust#200582) SHIP TO: Customer Pick Up-5PL ONE CIVIC SQUARE CARMEL,IN 46032 PRODUCT", t``� GAL1.�7lNS u16tI°)` v AE-90S 821.801 0.41091 97.20 TANK TEMP "' SPECIFIC,GRAVE/Y ?" PPG, %ASPHA'LT DAT 010 172.0000 1.0131 8.4547250000 Aug15 2016 10:41AM ET HAiULER DRIVER TRACTOR# ER, TRUCK Co FNTA1NIrD CONTAINEFY N�ETAiIS; ,!.., a... n.e+.. .. . Randy 002 20(5PL) 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. This product meets AASHTO MP1 and was produced in accordance with the INDOT ASC program.This transport was inspected prior to loading and found acceptable for the material shipped in accordance with AASHTO PP26. Scalehouse Operator: Lewis,Chris Driver certifies that the cargo tank supplied for this shipment is a proper container for the transportation of this commodity and that proper placards have been applied. Driver Signature: R Q Customer Signature: EMULSIFIED ASPHALT �-WARNING--- May produce minor burns on contact/ 1. Hot emulsified asphalt may produce severe burns on contact to eyes or skin.Frequent or prolonged skin contact may cause irritation and dermatitis. 2. Stay upwind and vent container before unloading.Vapors and fumes may irritate the nasal and respiratory tracts.Extended exposure can cause dizziness and nausea. 3. Keep container away from heat,flame,sparks,or other sources of ignition.'Do not pressurize,cut,weld,braze,solder,drill,or grind on this container, even if empty. DO NOT TRANSFER TO UNLABELED CONTAINER Refer to the Safety Data Sheet for more detailed information and emergency rust aid procedures. 24 Hour Emergency Number:CHEMTREC(800)424-9300 General SDS Assistance:1-317-875-4670 24-HOUR EMERGENCY RESPONSE NUMBER:CHEMTREC 1-8001124-9300 Ticket Number:IN-25511 HERITAGE GROUP COMPANIES CCN#10435 FOR EMERGENCY RESPONSE INFORMATION,SEE DOT GUIDEBOOK GUIDE#27 NR,This product is not regulated as a hazardous material by the US DOT. DELIVERY TICKET Asphalt Materials Inc. 4902 W.86th Street Indianapolis, IN 46268 SOLD TO: CITY OF CARMEL(Cust#200582) SHIP TO: Customer Pick Up-5PL ONE CIVIC SQUARE CARMEL,IN 46032 PR41bUCT , . °' ; !I i A', % ' PII;T ,jE TONS ' t NEM GA1-LiNS0° AE-90S 821.801 0.41091 97.20 ,TAN1� R '°' "i(:MF�1 3PECI IC GRAVITY pPG A °/a ASPi�ALT11 ' �2 �€!. ,to 3 3 010 172.0000 1.0131 8.4547250000 Aug15 2016 10.41AM ET HAkiLER DRIVER 7T RACI OR# lit rev' TRt�CKOASTCOt�TA1Nlc�„E GONTAI(N1F�N�pl:tA[i°�,, �. Randy 002 20(SPL) 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. This product meets AASHTO MP1 and was produced in accordance with the INDOT ASC program.This transport was inspected prior to loading and found acceptable for the material shipped in accordance with AASHTO PP26. Scalehouse Operator: Lewis,Chris Driver certifies that the cargo tank supplied for this shipment is a proper container for the transportation of this commodity and that proper placards have been applied. Driver Signature: Ftp Customer Signature: EMULSIFIED ASPHALT ---WARNING--- May produce minor burns on contactl 1. Hot emulsified asphalt may produce severe burns on contact to eyes or skin.Frequent or prolonged skin contact may cause irritation and dermatitis. 2. Stay upwind and vent container before unloading.Vapors and fumes may irritate the nasal and respiratory tracts.Extended exposure can cause dizziness and nausea. 3. Keep container away from heat,flame,sparks,or other sources of ignition.Do not pressurize,cut,weld,braze,solder,drill,or grind on this container, even if empty. --DO NOT TRANSFER TO UNLABELED CONTAINER-- Refer to the Safety Data Sheet for more detailed information and emergency first aid procedures. 24 Hour Emergency Number:CHEMTREC(800)424-9300 General SDS Assistance:1-317-875-4670