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315549 8/30/2017 CITY OF CARMEL, INDIANA VENDOR: 360202 CHECK AMOUNT: $*******331.41* ONE CIVIC SQUARE 982 PRAXAIR DISTRIBUTION INC CHECK NUMBER: 315549 60 i� ,_ CARMEL, INDIANA 46032 DEPT CH PALATINE�IOL660055-0660 CHECK DATE: 08/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPBOTTLED GAS TION 1120 4231100 78504912 331.41 o > 9 N) I M O k § § 2 \ ® 0 z ® m n / w m \ ) < / / g / O 7 S Q w 9 2 *w \ Uk CP 2 0 k � � \ � m > q k ƒ \ CD 0 m 3 § © e CL -i 2 z 2 4O < e 2 Q ) / m | \ 6 I / i a # � z E $ [ k ƒ C= § % i = ƒ E 7 J m : ° to ° \ 71 0 R ) CL 2 $ Cr CD 2 / w § E » E - E \ ƒ k $ 3 8 ƒ _ = a . \ @ k k = to - _ , k k k { & < [ -4 , ; R E y & / m k ƒ § « f a | o cr / 7 \I G m § k = q k$ \ . § 2 ) } D \ ' - 0 \ C E CD § \ 0 � < - 'a o 0 8 2 g k 9CD ƒ ° 2 2 m ƒ k k C o 2 / � p \ f � / 2 ik § k } | � 0< % & D �k m D \/ & � E \ § m / /f 0 / 8 j E \ \ O I ¥ z. C Z CD j k @ % CD / k \ p CDCL - /� / } k § / \ § k § CL _ D ƒ CD w - s ° 6 i ) PLEASE DETACH AND RETURN TOP PORTION WITH 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 UOM VOL/WT UNIT AMOUNT TAX SHIP RETN ORDER PRICE Y/N' INVOICE NO:78504912 CUSTOMER:71675029 DATE:8/11/2017 SHIP FROM 70613,PXPKG INDIANAPOLIS IN HS ORDER REFERENCE 41362269 DT 8/10/2017 PT# CUSTOMER PO/RELEASE VERBAL TOM PAYNE SHIP VIA Our Truck SHIP TO ACCOUNT:76168978 TOM PAYNE 317-741-0153 OX M-AD OXYGEN USP AD 11 18 CO 25.36 278.96 N UMSCFCD2 ENERGY AND FUEL CHARGE 1 EA 12.50 12.50 N UZZZHMD3 HAZARDOUS MATERIAL CHARGE 1 EA 13.95 13.95 N UDELIVERYCHARGE DELIVERY CHARGE 1 EA 26.00 26.00 N Total Cylinders Shipped/Returned 11 18 ACCOUNTS PAST DUE WILL BE CHARGED PLEASE NOTE PAYMENT OF THIS INVOICE ACKNOWLEDGES THAT SUBTOTAL TAX AMOUNT 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 N YOUR POSSESSION IS CORRECT AT THEANNUAL ,1 BALANCE,WEHICHEVER IS GREOF THE ATER OR CLOSE OF BUSINESS OING N THE DATE SHOWN ON THIS INVOICE. ',3'31.41 0.00 VSD $ 331.41 CONTRACTUALLY ALLOWED. 343-01F