192390 12/07/2010 CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $484.50
CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY
CHICAGO IL 60686 CHECK NUMBER: 192390
CHECK DATE: 12/7/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BMS891429 484.50 OTHER EXPENSES
BRENNTAG
NVOICE BMS891429 INV DATE: 8/27/10 PAGE 1 OF 1
DUE DATE: 9/26/10
OLD TO: SHIP TO:
-ARMEL WASTE WATER CARMEL WASTE WATER
3450 WEST 131ST STREET 9609 N. RIVER ROAD
dESTFIELD IN 46074 CARMEL IN 46280
REPRINT REPRINT REPRINT REPRINT REPRINT REPRINT
EDERAL ID 610504545 DATE SHIPPED: 8/27/10 TERMS NET 30 DAYS
/L 570979 -00 SHIP WHS: 29 SALESPRSN: 294
USTOMER 407542 SHIP VIA: OUR TRUCK PKG
USTOMER PO 512251 FOB DELIVERED
TAX EX# 356000972 -001 -9
NITS SHIPPED PROD WGT /GAL TOTAL QTY UNIT PRICE EXTENDED
1.0000 253418 11.870 2000.0000# .2250 450.00
2000.0000 CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
ESTIONS, CALL 317- 898 -8632
REMIT TO ADDRESS:
BRENNTAG MID SOUTH, INC
3796 RELIABLE PARKWAY
CHICAGO IL 60686 -0037 MERCHANDISE 450.00
INS SEC SURCHARGE 25.00
PAID ON OR PRIOR TO 9/26/10 INVOICE TOTAL 475.00
PAID AFTER 9/26/10 INVOICE TOTAL 484.50
Original Document
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VOUCHER 106676 WARRANT ALLOWED
359584 IN SUM OF
BREENTAG (ULRICH)
3 ?q6 �e llw r A'4t kw j
�h 14 6006
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Vail Code
BMS891429 01- 7182 -05 $484.50
Voucher Total $484.50
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
BREENTAG (ULRICH) Purchase Order No.
Terms
Due Date 12/2/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/2!2010 BMS891429 $484.50
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
Date Officer