182277 02/17/2010 a CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC
CHECK AMOUNT: $1,835.00
CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY
CHICAGO IL 60686 CHECK NUMBER: 182277
CHECK DATE: 2/17/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 780580 1,835.00 OTHER EXPENSES
Brcnntag Mid South, Inc. 13RENNTAG
1405 Highway 136 W P.O. BOX 20
Henderson, Kentucky 42419 -0020
INVOICE BMS780580 INV DATE: 2/01/10 PAGE 1 OF 1
DUE DATE: 3/03/10
SOLD TO: SHIP TO:
CITY OF CARMEL UTILITIES CARMEL WATER, PLANT 5
3450 WEST 131ST STREET 5484 E. 126TH STREET
WESTFIELD IN 46074° CARMEL IN 46032
V
v
FEDERAL ID 610504545 DATE SHIPPED: 2/01/10 TERMS NET 30 DAYS
B/L 430267 -00 S HIP WHS: 29 SALESP 29
CUSTOMER 407542 SHIP VIA: OUR TRUCK PKG
CUSTOMER PO VERBAL FOB DELIVERED
TAX EX# 356000972 -001 -9
UNITS SHIPPED PROD WGT /GAL TOTAL QTY UNIT PRICE EXTENDED
40.0000 805002 1.000 2000.00004 .9050 1,810.00
50.0000 BAG SOD FLUORIDE GRAN
>A F/S
QUESTIONS, CALL -317- 898 -8632
REMIT TO ADDRESS:
BRENNTAG MID- SOUTH, INC
3796 RELIABLE PARKWAY
CHICAGO IL 60686 -0037 MERCHANDISE 1,810.00
INS SEC SURCHARGE 25.00
PAID ON OR PRIOR TO 3/03/10 INVOICE TOTAL 1,835.00
PAID AFTER 3/03/10 INVOICE TOTAL 1,871.70
Original Document
Atlanta, GA Columbus, OH Indianapolis, IN Miami, FL St. Albans, WV
Bartonville, IL Georgetown, KY Kansas City, MO Nashville, TN St. Louis, MO
Calvert City, KY Greeneville, TN Kennesaw, GA Nitro, WV Tampa, FL
Chattanooga, TN Henderson, KY Louisville, KY Orlando, FL Terre Haute, IN
Clearwater, FL Huntsville, AL Memphis, TN Springfield, MO Valdosta; GA
ALL SALES SUBJECT TO AND GOVERNED BY THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE
VOUCHER 094310 WARRANT ALLOWED
369584 IN SUM OF
BRENNTAG MID -SOUTH INC
379b RELIABLE PARKWAY u fi
CHICAGO, IL 60686 -0037 r
i
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
780580 01- 6180 -03 $1,835 -00
Voucher Total $1,835.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, Kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
359584
BRENNTAG MID -SOUTH INC Purchase Order No.
3796 RELIABLE PARKWAY Terms
CHICAGO, IL 60686 -0037 Due Date 2/9/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/9/2010 780580 $1,835.00
1 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
Date Officer