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Home My WebLink About330109 09/19/18 4 CITY OF CARMEL, INDIANA VENDOR: 359584 1 ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $****1 1,534.47* CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK NUMBER: 330109 CHICAGO IL 60686 CHECK DATE: 09/19/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 080135 996.50 OTHER EXPENSES 601 5023990 080136 385.40 OTHER EXPENSES 1206 4350900 BMS079463 5,012.07 OTHER CONT SERVICES 1206 4350900 BMS087267 5,140.50 OTHER CONT SERVICES VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER Vendor# 359584 BRENNTAG MID SOUTH INC IN SUM OF$ CITY OF CARMEL 3796 RELIABLE PARKWAY 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. CHICAGO, IL 60686 Payee $10,152.57 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 BMS079463 43-509.00 $5,012.07 1 hereby certify that the attached invoice(s),or 8/31/18 BMS079463 Reflecting Pond Supplies $5,012.07 1206 101 1206 101 BMS087267 43-509.00 $5,140.50 bill(s)is(are)true and correct and that the 9/11/18 BMS087267 Reflecting Pond Supplies $5,140.50 1206 101 1 materials or services itemized thereon for 1206 1 101 which charge is made were ordered and received except Monday, September 17,2018 amo_ JU�� Lunn,Amy Admin Assistant 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 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer Brenntag Mid-South, Inc. BRENNTAGAEU 1405 Highway 136 W•P.O. BOX 20 Henderson,Kentucky 42419-0020 INVOICE#: BMS079463 INV DATE: 8/31/18 *** PAGE 1 OF 1 *** DUE DATE: 9/30/18 SOLD TO: SHIP TO: CARMEL STREET DEPARTMENT CARMEL STREET DEPARTMENT 3400 W. 131ST STREET REFLECTING POOL CARMEL IN 46074 THIRD AVE. & 126TH STREET CARMEL IN 46032 FEDERAL ID # : 610504545 DATE SHIPPED: 8/31/18 TERMST. : NET 30 DAYS 226961-00 - __ ____ _ _ ___ ____Sn1r V7HS-- - GJ ID.0 tSN:. 2�3 CUSTOMER # . : 897255 SHIP VIA: OUR TRUCK - PKG CUSTOMER PO# : REFLECTING FOB . . : DELIVERED FREIGHT TERM: PREPAID TAX EX# : 0031201550-020 PRO NUMBER . . UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 1319 . 9211 365998 10 . 14000 1319 . 9211G 3 . 6855 4 , 864 . 57 1 . 0000 G BULK SODIUM HYPOCHLORITE 12 . 5% DRUM OFF-330 G POLY TOTE>A BLK -------------------------------------------------------------------------------- 2 . 0000 931596 10 . 14000 10 . 000OG 5 . 0000 50 . 00 5 . 0000 G PAIL SODIUM HYPOCHLORITE 12 . 50-8 NSF/ANSI 60 >A RPK -------------------------------------------------------------------------------- QUESTIONS, CALL 317-898-8632 * REMIT' TO'ADDRESS * BRENNTAG MID-SOUTH, INC * 3796 RELIABLE PARKWAY * CHICAGO IL 60686-3007 * MERCHANDISE 4, 914 . 57 *************************************** FUEL SURCHARGE 97 . 50 ----------------- PAID ON OR PRIOR TO 9/30/18 INVOICE TOTAL USD 5, 012.07 PAID AFTER 9/30/18 INVOICE TOTAL USD 5, 112.31 Original Document ' "�ALL SALES SUBJECT TO AND GOVERNED BY THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE*** Brenntag Mid-South, Inc. B R E N N TAG _ 1405 Highway 136 W•P.O. BOX 20 Henderson, Kentucky 42419-0020 INVOICE#: BMS087267 INV DATE: 9/11/18 *** PAGE 1 OF 1 *** DUE DATE: 10/11/18 SOLD TO: SHIP TO: CARMEL STREET DEPARTMENT CARMEL STREET DEPARTMENT 3400 W. 131ST STREET REFLECTING POOL CARMEL IN 46074 THIRD AVE. & 126TH STREET CARMEL IN 46032 FEDERAL ID # : 610504545 DATE SHIPPED: 9/11/18 TERMS NET 30 DAYS 2254865-00 - - - - - - -SHIP -WHS_._ _— _ 29--SLSPRSN:- 293- CUSTOMER # . : 897255 SHIP VIA: OUR TRUCK - PKG CUSTOMER PO# : REFLECTING FOB . . : DELIVERED FREIGHT TERM: PREPAID TAX EX# : 0031201550-020 PRO NUMBER . : 778341113 UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 1320 . 0197 365998 10 . 14000 1320 . 0197G 3 . 8204 5, 043 . 00 1 . 0000 G BULK SODIUM HYPOCHLORITE 12 . 50 DRUM OFF-330 G POLY TOTE>A BLK -------------------------------------------------------------------------------- QUESTIONS, CALL 317-898-8632 *************************************** * REMIT TO ADDRESS: * BRENNTAG MID-SOUTH, INC * 3796 RELIABLE PARKWAY * CHICAGO IL 60686-3007 * MERCHANDISE 5, 043 . 00 *************************************** FUEL SURCHARGE 97 . 50 ----------------- PAID ON OR PRIOR TO 10/11/18 INVOICE TOTAL USD 5,140.50 PAID AFTER 10/11/18 INVOICE TOTAL USD 5,243 .31 Original Document M**ALL SALES SUBJECT TO AND GOVERNED BY THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE **x o� L�UIU8/�D��moH�� |{ute!p�. �*� uzOklnWeO TroN Prev�8us �a�o �� ga A ox �6 BRE#NTAG MID-SOUTH PHONE.- 237~898-8633 8/31/�8 0:Z5�40' ' � ~ �� N�NN�N�� 3111 W POST RD FAX: ' � '� �� @�� . DEA REG NO. 006601BNY ^ INDIHNAPUL%S, IN 46226 ' � BQL# . . : 2246961-00 DeIV Data: 8/31/18 Ship CARMEL STREET' DEP - MENT Sold CARMEL STREET DEPARTMENT Customer: 897255 Ship To: 2 Ship Date: 8/31/18 0 Ship To: REFLECTING POOL - To: 3400 W. 131ST STREET Attn- frt Terms: PREPAID Fri THIRD AVE. & 126TH STREET CARMEL, IN 46074 FOB. , . : DELIVERED Taken By : 8M29SLD SIS CARMEL, IN 46032 ` Ship Via: OUR TRUCK - PK . Placed By: MIKE ' ' ReCV Hrs: 8:00 AM- 1:00 PM Ph0Og#. -: 317-4-43-0841 Phone: ?17-443-0841 Ext- Phone: 3I7-443-0841 Ext: - TerMs, . : NET 30 DAYS, . [Vst PO# : REFLECTING QUANTITY QUANTITY PRODUCT CON SHIPPED PACKAGING HM DESCRIPTION M ORDERED BACK ORDERED CODE DEF IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT., CALL CHEMTREC TOLL FREE AT 1-800-4-24-9300 � 2� HOURS / 7 -DAYS . ' . . . i RO .UN17��" ' / / /HY9O[HLURITE SOLUTIONS, �| ' G III r RI POLLUTANT (SODIUM HYPOCHLORITE) RQ � 'DOT--SP 1.2412 ! ERG #: .154 ' ' ODIUM HYPOCHLORITE 12.5% NSF .DRUM OFF~330 G POLY TOTE 13384.000 1.0000 T/T ' .SODIUM HYPOCHLORITE 12'5% DRUM OFF-330 .800C 365998 ! � Loc: E811 E815 E707 E813 E710 E`^~ | Qty- .8000 764.0000 46.0 i Product picked from: ' L�o^ Lot: 36599829�2�1 S816 ^ ~ Qty. 6, )92.0000 ' | Lot: 365998298242 Loc: E713 6, )92.0000 ~ Freight ClaSs. . . : 55 N8iBht Per Gallon: 10.14000 Net Weight" , | | LK [ 'Hose cu/v/ecueua` 2 3 5 Driver- --------------------------------- - -^--`-t�=~~~^~~~-----~^----~- _____.______.__ ___ _____._~__ qU8Dtitv shipped will Fit into cU8t0 ier container. ( 'Customer: Continued on Next Page **|* | | | | This o�o�fi� marked, labeled, m condition for u�o�mcmue �able lations of Loaded By: _-_--~-~_-|. Ch|. ecked By: V�h��Ie'� Driver.- Signature -' --""- -~ - ~ |. y° ---~-~----�°`��-�7�- PURCHASER'S ACCEPTANCE OF THE GOODS COVERED DOCUMENT CONSTITUTE ACCEPTANCE M�l��: _�_ Time In/Ti ' OUt_____~______ BY,aEemmcaAyEmwFaLL W�oU pallats DlVUWood Pallets RtO:___________ MOREOVER,PURCHASER,IIERIfBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED--~`-'' Plastic Pallets Dl��__,.~,~_~ PI��t�� P�II�t� �tD�_,_.�_1__ Received by: Date: CU8TOK8EROOPY Bill of Lading/utl:Lpmen t Rec 1.p i, page a at :l REtVNTAG MID-SOUTH PHONE:: 0:t.7-898 -8622 3/21/18 0:2509 •. 3111 N, POST RD FAX- DEA AX- , - B R E N N T DEA REG NO. 006601.13NY INDIANAPOLIS, 1N 46226 BOL# : " 2246961. -00 Dely Date: 8/31/18 Ship CARHE.L STREET DEPARTMENT Sold CARNE 1.. Si';�� i��s�f''r^,i; �°;�'s'v'�" Customer: 397255 Sh' �; �`�':: �' 2 Ship iat�tP: i��'3!/1$ 0 Ship To: QPFLECTING POOL. To: 3 400 W 1 1ST, STREET Atte-- Fr"t: Terms: PREPAID Frt" , THIRD AVE. I 126TH STREET CnRMEL;, :Ty 460FOB. . . : DELIVERED Taken-194 BM298LD SIS ! CARMEL, IN 46032 • Ship Via; OUR TRUCK " PKG Placed By: MIKE Recv Hrs: 8:00 At'7 1:00 PM Phone#. . . 3177443-0841 Phone: :317._443--Ct841 Ext: iw'i-lone: 317-441-0241 En`s: Terms. . . NET 30 ,DAYS CE-st PO 2 M R1 L:ECTING QUANTITY QUANTITY PRODUCT CON' SHIPPED PACKAGING HM DESCRIPTION M ORDERED BACKORDERED CODE DEF IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: _ CCN3170 EMERGENCY CONTACT: . CALL dHEMTREC TOLL FREE -AT 1-800,424-9300 24 HOURS 1 7 DAYS 646.2 LV TOTE -330 GAL FULL. --------- IX 0111791, j HYPOC t-LOR:i T SO�JJT I,Oi+tS, ERG A: 1.54 p SODIUM HYPOCHLORITE ORIT'E 12.5 ; N& 2.0000 5.0000 Get! PAIL: .60DIUM HYPOCHLORITE 12.0 MS;'/'At'SI 60 >A, RPK 2.00.00931596 Loc: E4RIA E 4 R 2 A SHIPPING Qty: 3000000 22.0000 4,0000 Product picked from: Lot: 931596298236 Lo=w:: E:0:iAI r Qty: 2 0000 Freight Class. . . : 55 Weight; Per Gallon: 10.14000 Net I,,Ie;i.ght: 101.,400 PAIL ONLY PRODl1CT5-E�tyNl1F ACTUf�E lJ ATA itiSi 1..13'rliRIZED i ' PL.ANT LOCATION ARE CONSIDERED CERTIFIED." __. _.__ ,-. fatal Net Weight: 13,485 Total Gross Weight. ;+ I This is to certify that the above named materials are properly classi I sc` pack d,mar and labeled,and are in proper condition for transportation according to the applicable regulati s ra ortn!L.vLfB2 Loaded By: Checked By: � .... Signature of Shipper: Vehicle: ....................... Driver. ................ `.. PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE Miles:....................... Time In/Time Out, „,,,,,,,„,,,,,,,�, BY THE PURCHASER OF ALL TERMS ND.CONDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF Weed Pallets Blvd Wood Pallets Rtn: MOREOVER PURC SER'HE BY KNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S), , i ""' D `fid Plastic Pallets Blvd.. ,...�. . ... Plast` Pallets, Rtn .......... Received by. Date: ", .� � '" ) a Rill of Lading/Ghipment nocclp''!'. Page 1 of 2 iRENNTAG Nlb-SOUTH P400 217-290-0632 0:2500 3111 N POST RD FA& B It 1:IN N IT DaA REG NO. 0066DIRMY 1NDIANAPOLIS, IN 46226 q BOLI 2246961-00 Delv Date! 8/31/18 Ship CAROEL STREET DEPARTNENT Sold CARMEL "WeRy"T hU"PARfNFNT - Customer: 897235 Ship 7a"°. "A Ship Date: 8/32/18 O 'Ship To: REFLE&ING POOL TO: 2000 t. Frt Terms: PREPAID Frt THIRD AVE. & 126TH STREqT , . 0NAEL" 0 4204 FOB. . . : DELIVERED Taken By : EM29SLD - Sls 010L, SW 4600 Ship Via: OUR TRUCK - PKG Placed By: MIKE kecv Hrs: 8:00 A& 1.:00 PH Phone;;. 317-443-0841 Pkone: 117-443-0841 Ext Phone: 317�4430041 Ext: Terms. . : MET 30 DAYS Cust PO# REFLECTING QUANTITY fl QUANTITY PRODUCT CON SHIPPED PACKAGING HM DESCRIPTION M ORDERED BACKORDERED CODE DE IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: CCNA170 EHERGENCY CONTnCT: &Li CAMTREC TOLL FREE 'AT 1-800-424"9300 24 HOURS / 7 VAQ, Fk,t;:IWHT 0RRIER: PAPER-INVOICE ROC. 0 oOl INVOICE THS. x1va, CONTi�hiCf 1111KE: 317-443-0341 PLQUESTING DELIVERY BY I PH ITRAY01 TRUCK ONLY YO A PELIVERaP AMD APPLIEP ,PIRECTLY TO THE ! REFLECTING POOL. CITY EMPLOYEE TS TO 31 PRESENT DURING ALL AELIVERIES AND 0PLICATIONS- NO EXCEPY10MS11 ---------------------------------------------------------------------------------------- ------------- Continuec an hell Page 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. Loaded By: Checked By: . ............... Signature of Shipper: Vehicle: ---- -------- ... Driver y ....... PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE Mile=....................... Time In/Time Out............ BY THE PURCHASER OF ALL TERMS AND CONDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF. Wood Pallets DlYd..... Wood Pallets Rtn: MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S). Plastic Pallets Dlvd--' Plastic Pallets Rtn:......... Received by: OW )ALI Date: 009T GMER COPY Bill of Lading/Shipmerlt Receipt Continued from Previous Page Page 2 of 3 BREN14TAG MID-SOUTH PHONE: 817-898--3632 9/11/18 a:47:24 8BRENNT 1.11. N POST RD EoX:" DEA REG NO. 00660IBNY INDIANAPOLIS, IN 46226 BOL# . : 2254865-00 Delv Date: 9/11/18 Shap CARMEL STREET DEPARTMENT '"Sold CARMEL STREET DEPARTMENT Customer: 897255 Shap To: 2 Ship Date: 9/11./1.8 0 Shap To: REFLECTING POOL To: 3400 W. 131ST STREET Attn- - F,rt Terms: PREPAID Frt 1 THIRD AVE. & 126TH STREET- CARMEL, IN 46074 FOB. . . : DELIVERED Taken By : BM29SLD SIS I CARMEL, IN 4603.2 Ship Via: OUR TRUCK - PKG Placed By: MIKE Recv Hrs: 8:00 AM- 1.:00 PM Phone#. 317-443-0841. Phone: 317-443--08.41. Ext: Phone: 317--443--0841, Ext: Terms. . : NET 30 DAYS Cust PO# REFLECTING QUANTITY SHIPPED PACKAGING HM DESCRIPTION M QUANTITY PRODUCT CON" ORDERED BACK ORDERED CODE DEF IF LEAK OR SPILL OCCURS bURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT: CALL CHEMTREC TOLL FREE T 1-800-424-9300 24 HOURS / 7 DAYS I , RQ UN1791, HYPOCHLORITE SOLUTIONS, 8,PG III MARINE POLLUTANT (SODIUM HYPOCHLORITE) RQ DOT-SP 12412 FRG #: 154 SODIUM HYPOCHLORITE 12.5% NSF DRUM OFF--330 G POLY TOTE 1.3384.0000 1.0300 -T/T SODIUM HYPOCHLORITE 12.5% DRUM OFF-330 G-POLY TOTE>A BLK 13384`.,8000 .8000 365998 Loc: E811 E815 E707 E813 E710 E816 Qty: .8000 610,0000 . , .46,0000 1066.5000 585.8000 876.0000' Product packed from: Lot: UWWOWN `t �4 Loc: ZZZ Qty: 0,{ 38.0000 Lot: 365998298243 - Loc: E814 Qty: 3,'146.0000 Freight Class. . , : 55 Weight Per Gallon: 1.0.14000 Net Weight: 1.3384.000 BULK To be completed for loading: . ____,_--__________ _ ____,____-___ Hose connected rr r� ar�tmen�t(s). 1; 2; 3; 4, 5 Driver. 1 ► o dose connec dMp p storage tank and quantity shipped will 1`it into custaner container„ Customer: .... . ..........�. ...........,,,,_..,,_,.. This is to certify that the above pane~d Materials are properly classified,described,packaged,marked,and labeled,a are in properOn tl"n41'd On I�E.'Xt Pc1L condition for transportation adegrding Co the applicable regulations of the Department of Transportation. C/., _'" � Loaded By: Checked By: ...............w,.,,. Signature of Shipper: R ,, „,. ,,,,,,,,,. PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE Veh1 cle: Driver: BY THE PURCHASER OF ALL TERMS AND CONDITIONS OF SALE STATED ON THE REVERSE SI�F�/HER/E. F. MA @STYd Time I n/Time MOREOVER,PUR SER, ACKNOWLEDGES EIPT OF L REQUIRED SDS(S). Wood Wood Pallets Plastic Pallets Dlvd Plastic Pallets by: Date: n:..... ..�._�...�� . ! CUSTOMER COPY Bill of Lading/Shipment Receipt; Page 3 of 3 BRENNTAG MID-SOUTH ``•-,PHONE: X632 9/11/18 3:47:24 BRENNT 3111 N POST RD 4 DEA REG NO. 00660IBNY INDIANAPOLIS, IN 46226 BOL# 2254865-00 Delv Date:, -9/1I/18 Ship CARMEL STREET DEPARTMENT Sold CARMEL STREET DEPARTMENT Customer: 897255 Ship To. - . 2 Ship Date:: 9/11/18 0 Ship To: REFLECTING POOL To: 3400 W. 131ST STREET Attn- Frt Terms:- PREPAID Frt C THikD AVE. & 126TH STREET CARMEL, IN 46074 FOB. . . : DELIVERED Taken By Z""BM29SLD SIS P CARHEL,, I1qJ,60?2 Ship Via: OUR TRUCK - PKG Placed By:� MIKE kecv Hrs: 8:00 AM- I:oo Pm Phone#. . 31.7-443-0841 Phone: 317-443-Cf841 Ext: Phone: 317-443-0841 Ext: Terms. NET 30 DAYS Cust PO# �' REFLECTING QUANTITYPRODUCT CONT PACKAGING HM DESCRIPTION M QUANTITY SHIPPED ORDERED BACKORDERED CODE DEP IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT: CALL CHEMTREC TOLL FREE )T 1-800-424-9300 24 HOURS j 7 DAYS x,346.2 LB TOTE 330 GAL FULL ---------------------- ---------------------- ----------------- ---------------------------- ------------- ------------------- - Total 4et Weight: 13,384 Totaj'i,-G oss Weight: 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. Loaded BY: Checked BY: ...... Signaffit4q hipper: Vehicle: ........... Driver. PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT SHALL CO ST TUTE ACCEPTANCE Miles.- BY THE PURCHASER OF ALL TERMS AND CONDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF. Time In/Time MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S). Wood Pallets Wood Pallets Received by: Date: Plastic Pallets Plastic Pallets Rtn: CUSTOMER COPY Page I 0--f 'A C-,, 41,1 D-5 9 R E'l 11r,I HIONE: 7-898-8632- ' 9/11/18 3:47:24- BRENNI N PUST RD F A X DEA REG NO. 006601.BNY 1111111AINAPOLIS, IN 44-226 -BOL# 2254865-00 Deiv Date: 9/11/18 Ship CARMEL 'oTREET '112PAR7MENT Sold CARMEL STREET DEPARTMENT Customer: 897255 Ship To: 2 - Ship Date: 9/11/18 0 Ship Yo Ri:_F 1-I" W.I't ID ECTI ;-,OoL Tsto: 3400 W. 131ST STREET Attn- F-rt Teraf : PREPAID Frt DELIVERED Taken By-'- TH '.i,26_FH E-r CARMEL, IN 46074 FOB. - BM295LD Sis 00RJiLl., 'TiN Ship Via: OUR TRUCK PKG Placed BY: MIKE Recv Hrs: 8:00 AM- 1:00 pM Phone#. .1: 31.7-443-0841 MET 30 DAYS phohe-, :011841,1. Ext-, Phone. 317-44,3-084.1 Ext. Gust PO# REFLECTING QUANTITY QUANTITY PRODUCT COIN PACKAGING HM,"', DESCRIPTION M SHIPPED ORDERED BACK ORDERED CODE DE IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT- CALL CHEMTREC TOLL FREE T 1-800-424-9300 24 HOURS / 7 DAYS fm FREIGHT CARRIER: INVOICE TMS,VIA,, EDI 'OR CARRIER PORTAL. .DRIVER: CONTACT MIKE'. 317-443-0841 CUSTOMER REQUESTING DELIVERY BY 12 PM STRAIGHT TRUCK ONLY CHEMICALS NEED TO BE DELIVERED AND APPLIED :,T)-IRECTLY TO THE REFLECTING POOL. CITY EMPLOYEE IS TO BE PRESENT- DURING ALL DELIVERIES AND APPLICATIONS- NO 1EXCEPTIONS;;,! w--------_-----.__------__'--_._,_w,---_.----- --------------------------------------_---7, _j L Continudd on Next Page 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. Loaded By: ...................... ChecKed By: Signature of Shipper: Vehicle: Driver: ............. ....... ................................... PURCHASER'S ACCEPTANCE OF THE GOODS COVERED BY THIS DOCUMENT&ALWL C�4TKUTE ACCEPTANCE BY THE PURCHASER OF ALL TERMS AND CONDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF, Miles: Time In/Tame out-_..------- MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S). Wood Pallets DIV Wood Pallets Rtn':.,,-....... Received by: Date: Plastic Pallets Plastic Pallets, Rtn CUSTOMER COPY VOUCHER NO. 182629 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor# 359584 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER BRENNTAG MID-SOUTH INC CITY OF CARMEL 3796 RELIABLE PARKWAY An invoice or bill to be properly itemized must show: kind of service,where performed, CHICAGO, IL 60686-0037 dates service rendered, by whom, rates per day, number of hours, rate per hour, numbers of units, price per unit,etc. Payee $1,381.90 359584 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR BRENNTAG MID-SOUTH INC Terms Carmel Water Utility 3796 RELIABLE PARKWAY Due Date BOARD MEMBERS I hereby certify that that attached invoice(s), CHICAGO,IL 60686-0037 PO# ACCT# or bill(s)is(are)true and correct and that the materials or services itemized thereon for DATE INVOICE# Description DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 080135 01-6180-03 $996.50 and received except 9/6/2018 080135 $996.50 080136 01-6180-03 $385.40 9/6/2018 080136 $385.40 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_ Clerk-Treasurer BRENNTAG BRENNTAG MID-SOUTH, INC. 1405 HIGHWAY 136 WEST PO BOX 20 HENDERSON KY 42419-0020 INVOICE#: BMS080136 INV DATE: 8/30/18 * PAGE 1 OF 1 *** DUE DATE: 9/29/18 SOLD TO: SHIP TO: CITY OF CARMEL UTILITIES CARMEL WATER, PLANT 4 3450 WEST 131ST STREET 10675 N. GRAY ROAD CARMEL IN 46074 CARMEL IN 46032 FEDERAL ID #: 610504545 DATE SHIPPED: 8/30/18 TERMS NET 30 DAYS B/L #. . . : 2244810-00 SHIP WHS: 29 SLSPRSN: 293 CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG CUSTOMER PO#: AC082819 FOB . . : DELIVERED FREIGHT TERM: PREPAID TAX EX# : 356000972-001-9 PRO NUMBER . : 777970061 UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 3 .0000 873311 11 .87000 450.0000# .5620 252.90 150.0000 # CYL CHLORINE, LIQUID (BMS ONLY) >A RPK -------------------------------------------------------------------------------- QUESTIONS, CALL 317-898-8632 * REMIT TO ADDRESS: BRENNTAG MID-SOUTH, INC 3796 RELIABLE PARKWAY * MERCHANDISE 252.90 CHICAGO IL 60686-3007 * FUEL SURCHARGE 97.50 INS & SEC SURCHARGE 35.00 ----------------- PAID ON OR PRIOR TO 9/29/18 INVOICE TOTAL USD 385.40 PAID AFTER 9/29/18 INVOICE TOTAL USD 393 .11 Original Document BRENNTAGA� BRENNTAG MID-SOUTH, INC. 1405 -HIGHWAY 136 WEST PO BOX 20 HENDERSON KY 42419-0020 INVOICE#: BMS080135 INV DATE: 8/30/18 PAGE 1 OF 1 * DUE DATE: 9/29/18 SOLD TO: SHIP TO: CITY OF CARMEL UTILITIES CARMEL UTILITIES PLT 1 3450 WEST 131ST STREET 4915 E 106 ST CARMEL IN 46074 CARMEL IN 46033 FEDERAL ID #: 610504545 DATE SHIPPED: 8/30/18 TERMS NET 30 DAYS B/L #. . : 2244815-00 SHIP WHS: 29 SLSPRSN: 293 CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG CUSTOMER PO#: AC082819 FOB . . : DELIVERED FREIGHT TERM: PREPAID TAX EX# : 356000972-001-9 PRO NUMBER . : 777970066 UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 1 .0000 253418 11 .87000 2000 .0000# .4320 864.00 2000 .0000 # CYL CHLORINE, LIQUID (BMS ONLY) >A RPK -------------------------------------------------------------------------------- QUESTIONS, CALL 317-898-8632 * REMIT TO ADDRESS: * BRENNTAG MID-SOUTH, INC * 3796 RELIABLE PARKWAY * MERCHANDISE 864.00 * CHICAGO IL 60686-3007 * FUEL SURCHARGE 97 .50 INS & SEC SURCHARGE 35.00 ----------------- PAID ON OR PRIOR TO 9/29/18 INVOICE TOTAL USD 996.50 PAID AFTER 9/29/18 INVOICE TOTAL USD 1 ,016.43 Original Document Nall of Lao?ng/!3I11pment Keceipt Continued from Previous Page Page 2 of 3 BRENNT AG MID-SOUTH PHONE: 817-898-8632 8/29/18 22:17:17 6 R E N N T, 3 ll "N' POST RD FAX: DEA REG NO, 006601BNY k" INDIANAPOLIS, IN 46226 _ BOL# . : 2244810-00 Dely Date: 8/30/18 Ship CARMEL WATER, PLANT Sold CITY OF CARMEL UTILITIES = Customer: 407542 Ship To: 6 Ship Date: 8/30/18 0 Ship To: 10675 N. GRAY ROAD To: 3450 FEST 131ST STREET Attn- Frt Terms: PREPAID Frt CARMEL, IN 46032 CARMEL, IN 46074 FOB. . . : DELIVERED Taken By : BM29LAL Sls I Ship Via: OUR TRUCK -- PKG Placed By: ANDY Recv Sirs: 8:00 AM- 4:00 PM Phone#. . : 317-571-2443 Phone: 317-716-3917 Ext: Phone: 317-571-2443 Ext.: Terms. .: NET 30 DAYS Cust PO# : AC082819 QUANTITY SHIPPED PACKAGING HM DESCRIPTION M ORDERED QUANTITY ACKORDERED PRODUCT R D E� CONI ODEP IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT: CALL CHEMTREC TOLL FREE AT 1=800-424-9300 24 HOURS / 7 DAYS 'RQ UN1.01.7, CHLORINE, RQ,MARINE POLLUTANT POISON-INHALATIONHAZARD, ZONE B ;ERG #: 124 CHLORINE .3.0000 1.50.0000 LB CYL CHLORINE., LIQUID (BMs ONLY] >A RPK 3,0000 873311 Loc: A2R2A - ;Qty: ' 35.0000, `Product picked from: Lot: 2 Loc: A2R2A Qty: 3",0000 .':Freigh•t Class. . „ : 200 ___.__ t#a# :_ e� Z q o`'1 Wei gh•tgPer-Gallon:�_-11.87000W-Net. Weight: N-_`;50.000- CYLy- ` Date : fJTotal Net yWeight. 450 Total Cross Weight". RID. # LAC-CT '� C Id'cJ This is to certify that the labove named materials are properly classified,descr' caged, azked, labeled,and are in proper condition for transportation according to the applicable regulations of pa of port ion. Loaded By: .................... „.....„ ....,,.„., ... Checked By: „.........,... Signature of Shipper: Vehicle: „.., Driver.. PURCHASER'S ACCEPTANCE OF THE GOODS COVERED Wood Palleiss DlTHIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE Miles: Time In/Time Out , BY THE PURCHASER OF ALL TERMS AND CONDITION F SALE STATED ON THE REVERSE SIDE HEREOF. ...„'„v„ ....""...... """""'„ MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEH'T OF ALL REQUIRED SDS(S�.^, d Wood Pallets Rtn: f I Plastic Pallets Dlvd ..,._.....,..... .„ Plastic Pal-letsRtn: Received by: ff / j`' - Date: E'/ 4 CUS i OMER COPY — „ BiX of (Lading/Shipment Receipt page 1, of 2 SRrrN ., G MID-SOUTH PHONE: 31.7-898-8632 8/29/1.8 22-17:38 7:38 6 R T, 3111 OST RD FAX: DEA REG 0. 006NY 601BE INDIANAPO IS, IN 46226 BOL# . : 2244815-00 Dely Date: 8/30/18. Ship CARMEL UTILITIES PLT -1. Sold CITY OF CARMEL UTILITIES Customer: 407542 Shap To: 11 Ship Date: ' 8/30/18 0 Ship To: 4915 E 106 ST To: 3450 WEST 131ST STREET 'Attn- Frt Terms: PREPAID Frt CARMEL, IN 46033 � , CARMEL, IN 46074 FOB. . . : DELIVERED Taken By : BM29LAL,p Sls Ship Via: OUR TRUCK - PKG Placed By: ANDY Recv Hrs: 8:00 AM- 4:00 PM Phone#. . : 317-571-2443 Phone: 317•-571-2443 Ext: Phone: 317-571.2443 Exit: '°_ "farms, . : NET 30 DAYS Cust PO# AC082819 QUANTITY QUANTITY PRODUCT ; CONI SHIPPED PACKAGING HM DESCRIPTION M ORDERED BACKORDERED CODE DEF IF LEAK OR .SPILL OCCURS DURING TRANSPORTATION: CCN3170 EMERGENCY CONTACT: CALL CHEMTREC TOLL FREE AT 1-800-424-9300 24 HOURS / 7 DAYS FREIGHT CARRIER: INVOICE TMS VIA EDI OR,BARRIER PORTAL. 2EFF 317-571-2639 ANDY 317--750-1479 'RQ-.UNIO17, CHLORINE, i RQ,MARINE POLLUTANT . POISON-INHALATION ,HAZARD, ZONE B . .__. ERG #: 124 `CHLORINE 1.0000 20QO.00P( LB CyCHLORINE, LIQUID (BMS ONLY) e >A RPK 1.0000 2534.18 SMI Loc: OSE05 OSE04 Qty: 6.0000 9.000.0 Product picked from: Lot: 2 Loc: OSE04 Qty: 1.0000 Freight Class. . . : 200 ''Weight Per Gallon: 1.1.87000 Net Weigh't:� 2000,000 CYL f Total Net Weight: 2,000 Total Cross Wei!jht: „This is to certify that the labove named materials are properly classifie scri pack ged,mar and labeled,and are in proper q condition for transportation according to the applicable regulatio e f Tra ortatio e� Loaded By: „ „ „ _ „ „ Checked By: Signature of Shipper: Vehicle: Driver: „ .�,�,� „ PURCHASER'S.ACCEPTANCE OF THE GOODS COVE D BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE Males: Time In/Tune Out BY THE PURCHASER OF ALL TERMS AND CONDIT NS OF SALE STATED ON THE REVERSE SIDE HEREOF. •.„.',,,,,,,,,,,,,,,,„lVd,.""""""""""'„'""""' MOREOVER,PURCHASER,HEREBY ACKNOWLEDGES RECEIPT OF ALL REQUIRED SDS(S) Wood Pallets D2Vd Wood Pallets Rtn:""" f l� Plastic Pallets Dlvd _„ Plastic Pallets. Rtn: ” Received by: f` r ± -'` f �._ `� Date: /1 ��'MER COSY „.... w CLIS T