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Home My WebLink About159205 05/14/2008 a,q,f CITY OF CARMEL, INDIANA VENDOR: 355856 Page 1 of 1 ONE CIVIC SQUARE AIRGAS MID AMERICA CHECK AMOUNT: $56.90 CARMEL, INDIANA 46032 PO BOX 802615 t off CHICAGO IL 60680 CHECK NUMBER: 159205 CHECK DATE: 5/14/2008 DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION 0601 5023990 111389974 56.90 MATERIALS SUPPLIES TO ENSURE PROPER CREDIT, PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: (304) 353 -6177 pRDER.NUMHER INVOICE- NUMBER! AGCOUNT::NUMBER" INVOICE DATE ACCOUNT:;NAME 185830 -00 111389974 A2F44 04/21/08 CITY OF CARMEL CUSTOMER OR{?ER`NUMt3ER >!!BRN SLS TERR SHIP -VIA "I` TERMS PAGE< WATER DEPT 014 14 14 PICK -UP NET 30 DAYS 1 DELIVERY ORDER CYLINDER U`: PART NUMBER Drr DTr DESCRIPTION O' PRf II ?NUMBER:.: DATE HP'D RETD x AMOUNT CE LOCATION: JYC 18583004:08 OX 20 1 0 OXYGEN INDUSTRIAL SIZE 2 CL 18.7400 18.74 N CGA 540 1 1 VOL: 19 18583004 AC MC 1 0 ACETYLENE SIZE MC (CL UO L 34.1600 34.16 N CGA 200 1 1 VOL: 1.0 18583004;081AZHAZMAT 1 0 HAZARDOUS MATERIALS CHAR EA 4.0000 4.00 N �BRU BUCKSOT 926 MEPER SHO Sub-otal 56.90 TOTAL CYLINDERS SHIPPED: 2 RETURNED: TAX C :0;00000001 TAX DESC P:IN IA SALE TAX CT:0031201550010 EX :01/01/37 TAXABLE'AMOUNT s AMOUNT RU THIS $56.90 'fNVOICE ��V SHIP TO: C• o www.airgas.com CITY OF CARMEL ACT. NAME AIRGAS MID AMERICA 3450 W 131ST ST ACT. NO. 8606074123 Airgas Mid America WESTFIELD IN 46074 -8267 PNC BANK, ABA NO. 031000053 PO Box 1117 REF. 111389974/A2F44 Bowling Green, KY 42102 -1117 ORIGINAL INVOICE Disclosures Terms of Sale: Each sale of goods or services by an AirgaSTM company shall be pursuant to the Terms of Sale affixed to the Account Application. The Terms of Sale can also ba found at Notice Regarding Cylinder Rentals/Leases and Responsibilit This Notice relates to rentals, leases and cylinder balances. his document shows the total number of cylinders charged \n you (that is cylinders which we have rented o/ leased to you, and which you have not returned) according to our records as of the month ending date shown, The number ofcylinders thus charged to you shall be considered correct for all contractual purposes between you and us, unless you report to us in writing any errors you claim within sixty (68) days after the date hereof. You agree to continue to pay rent on all cylinders charged to you until you have either (i) returned such cylinders to us in good working order or (ii) paid us the replacement cost thereof. U. for any reason, you cannot return any cylinder to us, you sha||, forthwith. upon our billing, pay uu the replacement cost thereof. Charges Itemized The total amount due from the customer (Buyer) may include various itemized uhurgau including: charges for the handling of hazardous materials and for compliance with laws and regulations concerning hazardous materials; charges for hond|ing, delivery and shipping; and/or charges for energy or fuel. None of the charges represent a tax or fee paid to or imposed by any government authority, and all of the charges are retained by the Company (Seller). The Company has not specifically quantified the relationship between the charges and the actual costs associated with the oha/goo, which can vary by p/oduot, oon/ino, time and p|ace, among other things. Contracts Government Certain Ai,gaa companies are U.S. government contractors and subcontractors and subject \u and adhere to the requirements of federal |aws, executive ord*rn, and attendant rules and regulations, specifically Executive Order No. 11246, the Rehabilitation Act of 1873 and the Vietnam Ere Vabarona Readjustment Assistance Act of 1974. all as amended Charges Finance Past due accounts will be charged a finance charge at the periodic rat* of one and one-half percent (1 1/2Y6) per munth, which is on annual percentage rate of 18%, or a periodic rate not to exceed the maximum nebe allowed hy state law. Now doing business with Airgos is easier than ever! Visit us online at With a username and pemsvvunj tied directly to your account, you'll 0e\ all of the benefits and uen/im* that you expect from Airgau. P|un much more: Pay invoices on|inm You now have the ability to pay invoices online with a credit card as well as to view 365 days of invoice information. 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VOUCHER 081620 WARRANT ALLOWED :55856 IN SUM OF 4AIRGAS MID AMERICA Z PO BOX 802615 CHICAGO, IL 60680 -2615 V Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code V 111389974 01- 6200 -06 $56.90 �j r 'i Voucher Total $56.90 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 355856 AIRGAS MID AMERICA Purchase Order No. PO BOX 802615 Terms CHICAGO, IL 60680 -2615 Due Date 5/2/2008 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/2/2008 111389974 $56.90 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