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312295 6/13/2017
CITY OF CARMEL, INDIANA VENDOR: 360202 ONE CIVIC SQUARE 982-PRAXAIR DISTRIBUTION INC CHECK AMOUNT: S""'""407.49' : CARMEL, INDIANA 46032 DEPT CH 10660 CHECK NUMBER: 312295 v PALATINE IL 60055-0660 CHECK DATE: 06/13/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 4231100 77550483 407.49 BOTTLED GAS -0 0 o < < ° m O / q / q O k § *k z ® 0 D 2 ? # 2 \ 0 m " / % q k 4 < z � k g O % ) ) --i k q E I k\ C#q \/ ) 2 41 \ > k / T G \ [ / ® 0 3 § © * $ zE / > k 2 9 i 0 | \ E ? \ c Sr z > 0 \ E 0 / ƒ . % i g i Q m @ q ] = G - Q c m , f 4 1.9 0 p F § #CL f I \ f k � Er m . & $ t CD CD % } § K 0 S 0 k k o_ @¢ k \ co CL m - < » / Sr 0) E § o § C y 3 , - _ = a f G ¥ q § CL U)\ CL Cr ° Q --1m \ § k i = / .« § \ -4 c < 0 0 _ a 0 E ] a� k 0 ƒ \ CL G © k ) / 0 Z \ g km k k A 00 \ E 2 D \ \ m ) 9 §o } v » 2 � \ r 2 0 0 0 E \ r r 0 E k 2 � « ) \ E ) C O m - % / \ § $ / k / . - 0 M -n Cl m f ] § L � k ® 10 z � \ \ § \ # 2 / 9 0 C) = ; :N Z \ PLEASEDETACHANDRETURNTOPPORTIONWITH PAYMENT QUESTIONS: COMMENTS: Please note the format of your invoice has changed and now includes more PRAXAIR DISTRIBUTION,INC. information to help you manage your Praxair account. 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 ITEM NUMBER ITEM DESCRIPTION CITY CITY BACK UNIT TQ SHIP RETN ORDER UOM VOLIWT PRICE AMOUNT ym INVOICE NO:77550483 CUSTOMER:71675029 DATE:5/27/2017 SHIP FROM 70613,PXPKG INDIANAPOLIS IN HS ORDER REFERENCE 92138008 DT 5/26/2017 PT# CUSTOMER PO I RELEASE VERBAL TOM SHIP VIA Our Truck SHIP TO ACCOUNT:76168978 OX M-AD OXYGEN USP AD 14 12 CO 25.36 355.04 N UMSCFCD2 ENERGY AND FUEL CHARGE 1 EA 12.50 12.50 N UZ77HMD3 HAZARDOUS MATERIAL CHARGE 1 EA 13.95 13.95 N UDELIVERYCHARGE DELIVERY CHARGE 1 EA 26.00 26.00 N Total Cylinders Shipped/Returned 14 12 ACCOUNTS PAST DUE WILL BE CHARGED PLEASE NOTE PAYMENT OF THIS INVOICE ACKNOWLEDGES THAT A SERVICE CHARGE OF$1 OR A FINANCE THE ABOVE SHIPMENTS,RETURNS,AND/OR BALANCE OF THE SUBTOTAL TAX AMOUNT CHARGE OF 1.5%PER MONTH(18% PRAXAR CYLINDERS N YOUR POSSESSION IS CORRECT AT THE ANNUAL RATE)OF THE OUTSTANDING CLOSE OF BUSINESS ON THE DATE SHOWN ON THIS INVOICE. BALANCE,WFBCHEVER IS GREATER OR 407.49 0.00 USD $ 407.49 CONTRACTUALLY ALLOWED. 343-01 F