308471 02/28/17 CITY OF CARMEL, INDIANA VENDOR: 360202
ONE CIVIC SQUARE 982-PRAXAIR DISTRIBUTION INC CHECK AMOUNT: $*******443.99*
CARMEL, INDIANA 46032 DEPT CH 10660 CHECK NUMBER: 308471
PALATINE IL 60055-0660 CHECK DATE: 02/28/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4231100 76098452 443.99 BOTTLED GAS
YL.tAJt LJt I AL.rl FIIVLI TCC I URIV I UT-r-UTC 1 Ivry VV I I r1 r-t%I IVIGIV 1
QUESTIONS: COMMENTS:
PLEASE REFER INQUIRIES REGEIRDING 7H)S iNVOFCE Please note the format of your invoice has changed and now includes more
OR171,h 5., g�x",w,.m .m=°s.zi5 ..e.�= mow.,., 3 i -'a: i"'.
information to help you manage your Praxair account.
PRAXAIR DISTRIBUTION,INC.
CUSTOMER SERVICE
1400 POLCO ST If you wish to receive the document electronically in the future,please contact us.
INDIANAPOLIS IN 46222
800-266-4369 Pay your bill by credit card! Call 1-800-266-4369 to start.
INVOICE DETAIL AND PURCHASE DESCRIPTION TERMS: Net 10 Days NT DUE>2l13/2Q17
CITY CITY BACK UOM VOLAVTAMOUNTUNIT
ITEM NUMBER ITEM DESCRIPTION SHIP RETN ORDER PRICE Y/h
INVOICE NO:76098452 CUSTOMER:71675029 DATE:2/3/2017
SHIP FROM 70613,PXPKG INDIANAPOLIS IN HS
ORDER REFERENCE 88479256 DT 2/212017 PT#
CUSTOMER PO/RELEASE TOM PHONE ORDER
SHIP VIA Our Truck
SHIP TO ACCOUNT:76168978
TOM 317-741-0153
OX M-AD OXYGEN USP AD 12 9 CO 25.36 304.32 N
OX M-M OXYGEN USP M 3 3 CO 29.74 89.22 N
UMSCFCD2 ENERGY AND FUEL CHARGE USSURFEE 1 EA 12.50 12.50 N
UZZZHMD3 HAZARDOUS MATERIAL CHARGE USSURFEE 1 EA 12.95 12.95 N
UDELIVERYCHARGE DELIVERY CHARGE USSURFEE 1 EA 25.00 25.00 N
Total Cylinders Shipped/Returned 15 12
ACCOUNTS PAST DUE WLL BE CHARGED PLEASE NOTE PAYMENT OF THIS INVOICE ACKNOWLEDGES THAT SUBTOTAL TAX AMOUNT INVOWigMOUNT
A SERVICE CHARGE OF$1 OR A FINANCE THE ABOVE SHIPMENTS,RETURNS,AND/OR BALANCE OF THE
CHARGE OF 1.5%PER MONTH(18% PRAXAIR CYLINDERS W YOUR POSSESSION IS CORRECT AT THE
ANNUAL RATE)OF THE OUTSTANDING CLOSE OF BUSINESS ON THE DATE SHOWN ON THIS INVOICE. 443.99 �.�� USD $ 443.99
BALANCE,WHICHEVER IS GREATER OR
CONTRACTUALLY ALLOWED.
343-01 F
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 360202
982-PRAXAIR DISTRIBUTION INC IN SUM OF$ CITY OF CARMEL
DEPT CH 10660 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
PALATINE, IL 60055-0660
Payee
$443.99
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire 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
76098452 42-311.00 $443.99 1 hereby certify that the attached invoice(s),or 2/16/17 76098452 $443.99
1120 101 1120 101
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
Friday, February 17, 2017
David Haboush
Fire Chief
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