187219 07/07/2010 CITY OF CARMEL, INDIANA VENDOR: 358445 Page 1 of 1
ONE CIVIC SQUARE ASHLAND SPECIALTY CHEMICALS
y,o CARMEL, INDIANA 46032 P o sox 116735
CHECK AMOUNT: $807.88
ATLANTA GA 30368 -6735 CHECK NUMBER: 187219
CHECK DATE: 7/7/2010
DE PARTMENT ACC PO NUM INVOICE NUM AMOUNT DESC
1110 4231500 26934 93491059 807.88 OIL
`L
REMITTANCE ADVICE ORIGINAL
Page 1(1
Invoice Number Invoice Date Due Date
17 Jun 2010 17 Jul 2010
LO Ashland Inc. P.O.Number Payment Terms Payer Number
1 Corporate Headquarters stock Net 30 Days 344796
O1 50 East RiverCenter Blvd
w
Covington KY 41011 Shipped From Carrier Bill -To Number
USA NOBLESVILLE HERRIMAN BLVD PKG ASHLAND FLEET INDIANAPOLIS 15280 344796
Bill of Lading Number Incoterms DDP Dest, Frt Prepaid Ship -To Number
2581666 1344799
Billing address Shipping address
t CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
3 CIVIC SO 3400 W 131 ST ST
CARMEL IN 46032 -2584 CARMEL IN 46032
City. UOM Material Number Material Description Batch Billing Oty UOM Unit Price Amount
Number I USD
2 DR UM741 ULTRAMAX 5W30 DR 55 GA 2 DR 401.1150 802.23
Fuel /EnergySurcharge 5.65
Should you have any questions regarding this Invoice Total
invoice, please contact USD 807.88
DANA HAMMONDS
at 859 357 -2696
Remit to ACH Credit Wire transfer
P.O. Box 116735 Ashland Inc. Ashland Inc.
ATLANTA GA 30368.6735 Account Number: 0968468 Account Number:40502427
Mellon Bk NA Citibank NA
Bank 10:043000261 Bank -ID: 021000089
Please refer to the invoice number on the remittance.
Please return remittance advice with your payment. Alf.
Comments:
Vafvaline®
Federal ID number 20- 0865835 D-U-N-S number 00 -500 -3264
The terms and conditions of this sale are set forth at http://www,ashiand.com/salesterms-
Print date 18 Jun 2010
visit us at www.ashiand.com
INDIANA RETAIL TAX EXEMPT PAGE
C1
rme CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972
3= CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 voucHl =R, DELIVERY MEMO, PACKING SLIPS,
SHIPPING
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Jur�e 1 5, 7 010
oil
SHIP
VENDOR Ashland City of Carmel Maintenance Facility P.O. Box 116735 To 3400 W. 131st Street.
Atlanta, GA 30368 Westfield, IN 46074
OONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
N
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
2 55 gallon drums of oil 401°12 802024
11\
R•
v",
Send Invoice To:
City of Carmel Poiic epa, e]Wj
ATTN z Teresa Anderso'
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 315 oil PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
,l
C.O.D. SHIPMENTS CANNOT BE ACCEPTED, ORDERED BY S'Cii t' f I t 4y,, 4
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. 2 6 e�J 3 4 A.RV. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOU,CHFR NO. .WARRANT NO.__
'J.
ALLOWED 20
i
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
[DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signature
Title
Cost distribution ledger classification if
claim paid rnotor vehicle highway fund
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
r,
CITY OF CARMEL
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.
Payee
Ashland Purchase Order No. 26934'
P.O. Box 116735 Terms
Atlanta, GA 3036846735 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/17/10 93491059 payment for oil 807.88
Total
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
Clerk- Treasurer
VOUCHER NO. WARQANT NO.
F
ALLOWED 20
Ashland IN SUM OF
P.O. Box 116735
Atlanta, GA 30368 -6735
807.88
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
26934F 93491059 315 807.88 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
June 22 20 10
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund