165637 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 355856 Page 1 of 1
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ONE CIVIC SQUARE AIRGAS MID AMERICA
CARMEL, INDIANA 46032 PO BOX 802615 CHECK AMOUNT: $91.82
CHICAGO IL 60680
CHECK NUMBER: 165637
CHECK DATE: 11/12/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 111310919 91.82 MATERIALS SUPPLIES
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q1l 11 ii MR01 1 1111o; le! jIsil 111I
TO ENSURE PROPER CREDIT, PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE. FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: (304) 353 -6177
ORDERiNUMBER fNV01 E Nl1MBER "ACCOUNT NUMBER INVOICE pATI ACCOUNT NAME
013465 -00 111310919 A2F44 10/23/08 CITY OF CARMEL
CUSTOMER ORDER NUMBER <BRN• SLS TERR SHIP:VIA TERMS PAGE
CARMEL WATER DISTRIB 014 14 14 PICK -UP NET 30 DAYS 1
DELIVERY ORDER CYUNQER U UNIT
TE PART NUMBER RE'
�TM °Tj DESCRtPT1QN O AMOUN€
Nl3MBER :t0A sH�p o a(3, sr o PRIG:
LOCATION: C
1346 1020 X 80 1 0 OXYGEN INDUSTRIAL SIZE 8 L 25.8400 25.84 N
CGA 590
1 1 VOL: 85
1346 1020 C 3 1 0 ACETYLENE SIZE 3 (CL UOM CL 61.9800 61.98 N
CGA 510
1 1 75CF 82.6400/100 CF
:SIGNED FOR BY J.S. #2038
1346 1020 AZHAZMAT 1 0 HAZARDOUS MATERIALS CHAR EA 4.0000 4.00 N
S b otal 91.82
TOT L CYLI DE2S SHIPPED: 2 RETURNED:
TAX :Oi00�000001 TAX DESC P:IN SALE TAX CT:0031201550010 EX :01/01/37
TAXABLE AMOUNT AMOUNT
$.00 THlS 1NVOIGE $91.82
SHIP TO:
Alrgas. 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. 111310919/A2F44
Bowling Green, KY 42102 -1117
ORIGINAL INVOICE
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Disclosures
Terms of Sale: Each sale of goods or services by an Airgas'm company shall be pursuant to the Terms of Sale affixed to
the Account Application. The Terms of Sale can also be found at http: /www.aircias.com /customer service /terms.aspx.
Notice Regarding Cylinder Rentals /Leases and Responsibility This Notice relates to rentals, leases and cylinder
balances. This document shows the total number of cylinders charged to you (that is, cylinders which we have rented or
leased to you, and which you have not returned) according to our records as of the month ending date shown. The
number of cylinders 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 (60) 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. If, for any reason, you cannot return any cylinder to us, you shall, forthwith, upon
our billing, pay us the replacement cost thereof.
Itemized Charges The total amount due from the customer (Buyer) may include various itemized charges, including:
charges for the handling of hazardous materials and for compliance with laws and regulations concerning hazardous
materials; charges for handling, 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 charges, which can vary by product, service, time and place, among other things.
Gove rnment Contracts Certain Airgas companies are U.S. government contractors and subcontractors and subject to
and adhere to the requirements of federal laws, executive orders, and attendant rules and regulations, specifically
Executive Order No. 11246, the Rehabilitation Act of 1973 and the Vietnam Era Veterans Readjustment Assistance Act of
1974, all as amended,
Finance Charges Past due accounts will be charged a finance charge at the periodic rate of one and one -halt percent
(1 1/2 per month, which is an annual percentage rate of 18 or a periodic rate not to exceed the maximum rate
allowed by state law.
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VOUCHER 083512 WARRANT ALLOWED
355856 IN SUM OF
`AIRGAS MID AMERICA
PO BOX 802615
CHICAGO, IL 60680 -2615 A���•ti
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
f
Board members
PO INV ACCT AMOUNT Audit Trail Code
111310919 01- 6200 -06 $91.82
Voucher Total $91.82
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 t
CITY OF CARMEL
An invoice or bill to be properly itemized must show, hind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
r'
Payee
355856
AIRGAS MID AMERICA Purchase Order No.
PO BOX 802615 Terms
CHICAGO, IL 60680 -2615 Due Date 11/3/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/3/2008 111310919 $91.82
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 f O is r