313841 07/18/17 r c�gM
S *. CITY OF CARMEL, INDIANA VENDOR: 367949
D ONE CIVIC SQUARE MILLER INDUSTRIAL FLUIDS LLC CHECK AMOUNT: $**.....130.16*
CARMEL, INDIANA 46032 1751 N RAYMOND ST CHECK NUMBER: 313841
INDIANAPOLIS IN 46221 CHECK DATE: 07/18/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 45130 130.16 OTHER EXPENSES
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MMILLER Invoice Number Invoice Date 45130 6/22/2017
MILLER INDUSTRIAL FLUIDS,LLC Order Number Due Date
48716 7/22/2017
1751 W. Raymond St. Phone: (317) 634-7300 Fax: (317) 636-6761
Indianapolis, IN 46221 USA
INVOICE
Sold To: Ship To:
City of Carmel Utilities City of Carmel/Water Treatment
3450 W 131st St Plant
Carmel, IN 46074 4915 E 106th St
USA Carmel, IN 46033
USA
Ship Date Shipped Via Freight Terms Payment Terms
6/13/2017 Sales will Deliver-Herb Net 30
Purchase Order Number Sales Agent Order Date Customer Number
3M060717 Herb Simpson 6/7/2017 CITYCARMEL
Qty Shipped Packaging Total Product Unit Price Amount
uanti
2. 1 CTN CTN 2. CTN Mobil Polvrex EM 65.080/ CTN 130.16
14102EX1014
Mobil Polyrex EM
Merchandise SubTotal 130.16
Total Invoice 130.16
Please Remit Payment To: Miller Industrial Fluids, LLC • 1751 W. Raymond St. • Indianapolis, IN - 46221 USA
STRAIGM.,. ttlni `'L OF LADING
MILLER
From: dustrial Fluids,Inc. 10LC 6 7 17
MILLER INDUSTRIAL FLUIDS,L
a? N
At: 1751 W. Raymond St.
Indianapolis,IN 46221 48716
PHONE:(317)634-7300 FAX:(317)636-6761 Page 1 of 1
B City of Carmel Utilities H City of Carmel/Water Treatment Plant FOR CHEMICAL
I 3450 W 131st St I 4915 E 106th St EMERGENCY
L Carmel, IN 46074 Carmel IN 46033 SPILL,LEAK,
P
L USA USA DFIOR ACCIDENT
T 317-716-6624 T 317-716-6624 CALL:CHEMTREC
Q 0 DAY OR NIGHT
? , ...?-....., SHIPMENTS VIA D.O.T.HAZARDOUS MATERIALS PLACARDS FURNISHED BY: 800-424-9300
CITYCARMEL one Sa es will Deliver-Herb MOTOR CARRIER Ll SHIPPER ❑ CARRIER
31
1_111__;;1519
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IM060717 6/13/2M Yes
QUANTITY QUANTITY PACKAGING HM DESCRIPTION NET WEIGHT GROSS FRT
ORDERED SHIPPED WEIGHT CLS
2 2 1 CTNCTN Mobil Polyrex EM 0 0
14102EX1014 Mobil Polyrex EM 2 CTN
Total Weights: 0 0
ARIYERED JUN 3 0 2W
Received : T&Lm#u 2215Sr
Date : 6-2b—I'7
PO # : trema-:y"do i?
ACCT # : 4fzO-q
Use : rr�oTy��aras�- �15�5
SHIPPER'S CERTIFICATION This is to certify that the above named materials are properly classified,described,
pakaged,marked and labeled and are in proper condition for transportation according to the applicable SHIPPER'S CHECKLIST
ulationsofDOT. COD Amt: $ 0,00
(Signaturefritle)
If the shipment moves between two ports by a carrier by water,the law requires that the bill of DOT LABELS DOT DELIVERED BY:
lading shall state whether it is"carrier's or shipper's weight"NOTE-where the rate is dependent APPLIED AND AUTHORIZED
on value,shippers are required to state specifically In writing the agreed or declared value of SECURE CONTAINERS
the property. The agreed or declared value of the property is hereby specifically stated by the
shipper to be not exceeding per RECEIVED BY:
FREIGHT CHARGES PROPER DOT CHECKED FOR
NAME ON ALL PROPER
Subject to Section 7 of the conditions,if this shipment is If charges are to be PACKAGES SEALING
to be delivered to the consignee without recourse on the prepaid,write or
consignor,the consignor shall sign the following p he
stamp here,'TO BE
statement: PREPAID" AIR CARGO PELIGRO DATE:
ONLY LABEL APPLIED
The carrier shall not make delivery of this shipment
without payment of freight and all other lawful charges.
17- SIGNATURE HEREBY CONFIRMS
PLANT SHIPPING THAT QUANTITY SPECIFIED IS
(Signature of Consignor) / CORRECT AND RECEIVED IN
GOOD CONDITION