172202 05/13/2009 CITY OF CARMEL, INDIANA VENDOR: 359460 Page 1 of 1
ONE CIVIC SQUARE ASHLAND INC CHECK AMOUNT: $1,145.97
CARMEL, INDIANA 46032 P 0 BOX 116735
ATLANTA GA 30368 CHECK NUMBER: 172202
CHECK DATE: 5/13/2009
DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOU DESCRIPTION
1110 4231500 20112 92432664 1,145.97 55 GALLON DRUM OF OIL
I
1•-1LL�N�® REMITTANCE ADVICE
ORIGINAL
4 Page 1(1)
Invoice Number Invoice Date Due Date
92432664 27 Apr 2009 27 May 2009
q+
P.O,Number Payment Terms Payer Number
20112 Net 30 Days 344796
r
Shipped From Carrier Bill -To Number
NOBLESVILLE HERRIMAN BLVD PKGD ASHLAND FLEET INDIANAPOLIS 15280 344796
Bill of Lading Number Incoterms DOP Dest, Frt Prepaid Ship -To Number
1739212 344799
Billing address Shipping address
CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
3 CIVIC SQ 3400 W 131 ST ST
CARMEL IN 46032 -2584 CARMEL IN 46032
Qty. UoM Material Number Material Description Batch Billing Qt UoM Unit Price Amount
Number USD
1 DR UM741 ULTRAMAX 5W30 DR 55 GA 1 DR 422.9000 422.90
1 DR VV378 ATF DEXRON VI 1/55 GA 1 DR 718.9900 718.99
Fuel /EnergySurcharge 4.08
I
Should you have any questions regarding this Invoice Total
invoice, please contact USD 1,145.97
ADAM DUEK
at 859 -357 -2811
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 Sk NA Citibank NA
Bank- ID: 043000261 Bank- ID:021000089
Please refer to the invoice number on the remittance.
Please return remittance advice with your payment.
Comments:
poa 20112
Valvoline.
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.ashland.com /salesterms.
Print date 28 Apr 2009
visit us at www.ashiand.com
INDIANA RETAIL TAX EXEMPT PAGE
C1 I y o Carmel CERTIFICATE NO. 003120155 002 0 f lL Y 1i PURCHASE ORDER NUMBER
i Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 1
30,N, CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AM
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Apr'il 23, 2009 oil trassmission flihid
SHIP
VENDOR Ashland TO City of Cammel Mainteannee Facility
P.O. Box 116735 3400 W. 131st Street
Atlanta, GA 30368 Westfield, IN 46074
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1 55 gallnn drum of oil 415.64
1 55 gallnn drum of transmission fluid 718.99
ga
Send Invoice To:
PLEASE INVOICE IN DUPLICATE 1.134
DEPARTMENT ACCOUNT PROJECT, PROJECT ACCOUNT AMOUNT
1110 316 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.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL .4
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of POlice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
201; CLERK TREASURER
DOCUMENT CONTROL NO.
.COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. W WA'^RANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #MTLE 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 motor vehicle highway fund
Prescribed by Stale 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 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. 20112F
P.O. Box 116735 Terms
Atlanta, GA 30368 -6735 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/27/09 92432664 payment for:-oil and tranmi §Ilion fluid 1.145.97
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. WAORANT NO.
ALLOWED 20
A shland
IN SUM OF
P.O. Box 116735
Atlanta, GA 30368 -6735
1,145.97
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
20112F 92432664 315 1,145.97 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
May 7 20 09
r
Si nature
Chef of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund