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330276 09/21/18
CITY OF CARMEL, INDIANA VENDOR: 359584 CHECK AMOUNT: $*****4,051.30* ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK NUMBER: 330276 9yR9oii � CHICAGO IL 60686 CHECK DATE: 09/21/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 087509 4,051.30 OTHER EXPENSES VOUCHER NO. 182754 WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev 1995) ALLOWED 20 Vendor# 359584 IN SUM OF$ 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 $4,051.30 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 involce(s), CHICAGO,IL 60686-0037 or bill(s)is(are)true and correct and that Po# ACCT# 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 087509 01-6180-03 $4,051.30 and received except 9/13/2018 087509 $4,051.30 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. 20L— Clerk-Treasurer BRENNTAG BRENNTAG MID-SOUTH, INC. 1405 HIGHWAY 136 WEST PO BOX 20 HENDERSON KY 42419-0020 INVOICE#: BMS087509 INV DATE: 9/11/18 PAGE 1 OF 1 ** DUE DATE: 10/11/18 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: 9/11/18 TERMS NET 30 DAYS B/L #. . . : 2253062-00 SHIP WHS: 29 SLSPRSN: 293 CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK BULK CUSTOMER PO#: AC090618 FOB . . : DELIVERED FREIGHT TERM: PREPAID TAX EX# 356000972-001-9 PRO NUMBER . . UNITS SHIPPED PROD # WGT/GAL TOTAL' QTY UNIT PRICE EXTENDED -------------------------------------------------------------------------------- 11120.0000 437426 10.26000 11120.0000# .3400 3,780.80 1 .0000 # BULK HYDROFLUOSILICIC ACID 23% >A BLK -------------------------------------------- ----------------------------------- QUESTIONS, CALL 317-898-8632 REMIT TO ADDRESS: BRENNTAG MID-SOUTH, INC * 3796 RELIABLE PARKWAY * MERCHANDISE 3,780.80 * CHICAGO IL 60686-3007 * FUEL SURCHARGE 235.50 *************************************** INS & SEC SURCHARGE 35.00 ----------------- PAID ON OR PRIOR TO 10/11/18 INVOICE TOTAL USD 4,051 .30 PAID AFTER 10/11/18 INVOICE TOTAL USD 4,132.33 Original Document utrien- F r PCS SALES (USA) INC. Certificate Of Analysis AURORA Division - North Carolina, USA Shipment Numbe. Cat Number. Train Number. Date Shipped: '7339111-1 GATX 2717 21 Aug2018 Sold To: I Shlp-ro: PENCCO,INC. ROWELL TERMINAL P.O. BOX, 600 10100 S. ARCHER AVE. SAN FELIPE, TX 77473 WILLOW SPRINGS, IL 60480 Sold To P0: Ship To PC: 46419-39I Product: Quantity: HFSA I 95.750 ST Product Descriptli n: Gross Weigh: Tare Weigh~ 250700 23 PCT FI UOSILICIC ACID(HFSA) Net Weight 59200 191500 LB Analytical Value Units H2SIF6 23.6800 a H.M. AS PB < 0.0200 s APRA COLOR 9.0000 apha AS + PB < 9.3000 ppm HF 0.6100 a AS 8.3000 ppm PB < 1.0000 ppm SOLIDS PASS SPGR. 1.2200 TEMP 63.5000 F P205 0.0300 °s Brenntag Container Lot # � •�y` ""t'•i""� Laboratory Supervisor Remarks: WECERTIFY THAT PRODUCT LOADED INTO THE VESSEL MEETS AWWA STANDARD B703-00 AND ANSI/NSF STANDARD 60 REQUIREMENTS. MAXIMUM DOSAGE 6 MG/L. r Bill ©f Lading/Shipment Receipt _.. ��� Continued from Previous Page Page 2 of- 3 BENNTAG MID-SOUTH PHONE: 317-898-8632 9/10/18 9:37:33 B R E N N 3,'.'11 N POST RD FAX: IAEA REG NO. 00660IBNY INDIANAPOLIS, IN 46226 BOL# . : 2253062.00 Dely Date`:n .,9/11/1 Shap CARMEL UTILITIES OLT 1 Sold CITY OF CARMEL. UTILITIES Customer: 407542 Ship To: 11 Ship Date: ._.19/:11/18 0 Ship To: 497.5 E 706 ST To: 3450 WEST 131ST STREET Attn- Frt Terms: PREPAID Frt CARMEL., IN 46033 CARMEL, IN 46074 FOB. , : DELIVERED Taken By : BM29SLD SIS Shap Via: OUR TRUCK BULK Placed By: ANDY CREASY, Recv Hrs: 7:30 AM- 4:00 PM'. Phone#. 317-571-2443 Phone: 317.571-2443 Ext: Phone: 317-•571-2443 Ext: Terms. „ : NET 30 DAYS Cust PO# : AC090618 QUANTITY { PACKAGING HM DESCRIPTION " M QUANTITY PRODUCT CON SHIPPED ORDERED BACK ORDERED CODE DE IF LEAK OR SPILL OCCURS DURING TRANSPORTATION: _ CCN3170 EMERGENCY CONTACT: CALL CHEMTREC TOLL FREE AT -800-4249300 24 HOURS / 7 DAYS X UN1778, FLUOROSILICIC ACID, P,PG II ERG #: 154 fO,�d_Q HYDROFLUOROSILICIC ACID 235 f G� 1.0000 T/T HYDROFLQOSILICIC ACID 23-to >A BLK J±62tf 'iT"t?. 437426 Loc: .........TANK ,..25...................„.....,......„,..,...�..,.._„,,..,., o (�- 2�'( G Qty: 70610'�yy��g0 a � e C e iv-e4 Lot #: _.„.... .... .......... ... .....___..„... ......_. M ....„...._.„,.... a.t.e.. .... . ...... -t f(t Qty: �.. , , ,lc :�zs;... ...„.„.„..,.....�...,_.„....,. ......�....... „... ,.....�.�.......... ��...... „.„........... „.„.„_. - : Freight Class. . . . 55 Weight Per Gallon: 10.26000 Net Weight: 10260.000 BULK GC T #: <h To be comp).{�t d be�flo unloading: �__ �� --�_, w. _. ------------- US,o . LA Hose connect �,to co ect ompartrncnt(s) � a� � t� 5, Driver: „....,...,, !�...�;;.. ..„�.!���................ . ...... � � � � , I Hose connected to proper storage tanK and quantity shipped wi l fit into custoper container. Customer: .....................:. Continued on Next Page: **9 This is to certify that the above nam” erials are pro rl classified,describe0Jpackaged,marked,and,labeled,and are in proper condition for transportation accordin the applicable i g .� lations of the De�.s Cment of Transportation. ��} ^ Signature of Shipper: \�� _Y�' Loaded �3Y: .,....... ..,(X...,1.. Checked By, ........ ! !_ ..., p.. PURCHASER'S ACCEPTANCE OF THE`G,004S COV RED BY THIS DOCUMENT SHALL CONSTITUTE ACCEPTANCE ehacle: Driver: _ t r .....,,,.,. ,t.. /.s.........s .C�<1,,...... BY THE PURCHASER OF ALL TERMS AN��•.0•NDITIONS OF SALE STATED ON THE REVERSE SIDE HEREOF. miles: Time In/Time MOREOVER,PURCHASER,HEREBY ACKNO EDGES RECEIPT OF ALL REQUIRED SDS(S). Wood Pallets Dlvd Wood Pallets Rtn:,,,�,,, •„„ Received by: Date: 1 Plastic Pallets Dlvd,,,,,,,,,,,,,,_,,,,,,, Plastic Pallets Rtn:,,, ,„!„„„_„ CUSTOMER COPY