HomeMy WebLinkAbout332629 11/21/18 0�/ CITY OF CARMEL, INDIANA VENDOR: 359584
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $*******999.00*
s� fa4 CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK NUMBER: 332629
M��TUN�, CHICAGO IL 60686 CHECK DATE: 11/21/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BMS136974 999.00 OTHER EXPENSES
VOUCHER NO. 186851 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201 (Rev 1995)
Vendor # 359584 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
BRENNTAG (ULRICH) CITY OF CARMEL
3796 Reliable Parkway An invoice or bill to be properly itemized must show: kind of service,where performed,
CHICAGO, IL 60686 dates service rendered, by whom, rates per day, number of hours, rate per hour,
numbers of units, price per unit,etc.
Payee
999.00 359584 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR BRENNTAG(ULRICH) Terms
Carmel WaSterwater UtIGtY 3796 Reliable Parkway Due Date
BOARD MEMBERS
I hereby certify that that attached invoice CHICAGO, IL 60686
(s),
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT for which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
BMS136974 01-7182-05 $999,00 and received except 11/14/2018 BMS136974 $999.00
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20
Clerk-Treasurer
BRENNTAG
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
INVOICE#: BMS136974 INV DATE: 11/09/18 *** PAGE 1 OF 1 ***
DUE DATE: 12/09/18
SOLD TO: SHIP TO:
CARMEL WATER HAZEL DELL
3450 WEST 131ST STREET 9609 HAZEL DELL
CARMEL IN 46074 CARMEL IN 46280
FEDERAL ID #: 610504545 DATE SHIPPED: 11/09/18 TERMS NET 30 DAYS
B/L #. . . . : 2318366-00 SHIP WHS : 29 SLSPRSN: 293
CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG
CUSTOMER PO#: JC456 FOB . . : DELIVERED
FREIGHT TERM: PREPAID TAX EX# : 356000972-001-9
PRO NUMBER . : 780542618
UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED
--------------------------------------------------------------------------------
1 .0000 253418 11 .870. 00 2000.0000# .4320 864.00
2000 .0000 # CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
--------------------------------------------------------------------------------
Received by :
Date: f I-f9 - I� PO #: slc�osT
Acct #: 01 . -7 PF D S
Use: c�, ►.�-
QUESTIONS, CALL 317-898-8632
* REMIT TO ADDRESS:
BRENNTAG MID-SOUTH, INC
3796 RELIABLE PARKWAY * MERCHANDISE 864.00
* CHICAGO IL 60686-3007 * FUEL SURCHARGE 100.00
*************************************** INS & SEC SURCHARGE 35 .00
-----------------
PAID ON OR PRIOR TO 12/09/18 INVOICE TOTAL USD 999 .00
PAID AFTER 12/09/18 INVOICE TOTAL USD 1,018.98
Original Document
Brenntag Mid-South, Inc.
.RETURNED CONTAINER RECEIPT
Customer Name �'� �- ` B/L# - `-� Date <
QTY CODE DESCRIPTION CREDIT$ QTY CODE DESCRIPTION CREDIT$
827848 55 GAL STEEL DRUM 305564 100#ANHY AMMONIA CYL
929593 55 GAL STEEL DRUM RECON 797329 150#ANHY AMMONIA CYL
120431 5 GAL CARBOY
179417 100#CHLORINE CYL
VENDOR STEEL DRUM - 249173 150#CHLORINE CYL
617606 15 GAL DELDRUM , � 550384 TON CHLORINE CYL
505920 30 GAL DELDRUM v
430722 5S GAL DELDRUM 875152 150#SULFUR DIOXIDE CYL
VENDOR POLY DRUM 6317 TON SULFUR DIOXIDE CYL
181031 250#HYDROGEN PEROXIDE DR
411951 55 GAL DI WATER DRUM COMMENTS ABOUT CONTAINERS
248103 15 GAL STAINLESS STEEL DRUM
928859 55 GAL STAINLESS STEEL DRUM
638978 PLASTIC PALLETS
PORTABLE TANKS
-Product Name Tank# SS CS PL Product Name Tank# SS CS PL
Misc. Comments
ALL CONTAINERS MUST BE COMPLETELY EMPTY AND BUNGS INTACT AND SECURE.
CONTAINERS RETURNED I ,POOR CONDITIO�A1 RE SUBJECT TO LOSS OF DEPOSIT. .
\✓ qm�l
Customer Signature "( 7 / Driver Signature:
1
Form#1039 Rev 01/17