178614 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 358405 Page 1 of 1
ONE CIVIC SQUARE ASHLAND SPECIALTY CHEMICALS
CHECK AMOUNT: $1,889.75
CARMEL, INDIANA 46032 P O BOX 116735
ATLANTA GA 30368-6735 CHECK NUMBER: 178614
CHECK DATE: 10/2812009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231500 21236 92872445 1,889.75 OIL
�n
tAm!SN"LAN". REMITTANCE ADVICE ORIGINAL
Page 1(1)
r Invoice Number Invoice Date Due Date
92872445 15 Oct 2009 14 Nov 2009
m
P.O.Number Payment Terms Payer Number
N 1011212009 Net 30 Days 344796
ab
Shipped From Carrier M Number
NOBLESVILLE HERRIMAN BLVD PKGD ASHLAND FLEET INDIANAPOLIS 15260
Bill of Lading Number Incoterms DDP Dest, Fri Prepaid Ship -To Number
207980 344796
Billing address Shipping address
CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
3 CIVIC SO 3 CIVIC SQ
CARMEL IN 46032 -2584 CARMEL IN 46032 -2584
Oty. UoM Material Number Material Description Batch Billing Oty UoM Unit Price Amount
Number USD
s DR UM741 ULTRAMAX 5W30 DR 55 GA 5 DR 376.9160 1,884 -58
Fuel/EnergySurcharge 5.17
Should you have any questions regarding this Invoice Total:
invoice, please contact USb 1,889.75
ROBIN GOOLMAN
at 859 357 -2318
Remit to ACH Credit Wire transfer
R0. Box 116735 Ashland Inc. Ashland Inc.
ATLANTA GA 30368 -6735 Account Number>0968468 Account Number40502427
Mellon Bk NA Citibank NA
Bark-ID: 043000261 Bank-ID 021000089
Please refer to the invoice number on the remittance.
Please return remittance advice with your payment.
Comments:
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 16 Oct 2009
visit us at www.ashland.com
City INDIANA RETAIL TAX EXEMPT PAGE
o Carmed PURCHASE OR CERTIFICATE NO. 003120155 002 0 D E x DER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT 21236
35- 60000972
3}O 1kC1VIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
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
VENDOR Ashland SHIP City of Camel Police Department
P.Q. Box 116735 TO 3 Civic Square
Atlanta, GA 30368 -5735 CatWl, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
5 55 gallon drums of oil 386.92 1,884 »58
f
0
•ee
c o o
Send Invoice To:
1
1
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 APPROPRIATICI UFFICIENT TO PAY FOR THE ABOVE ORDER,
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY J
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 5945 TITLE Zssistant Chiefo6f Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2123 CLERK- TREASURER
DOCUMENT CONTROL NO. A.P. COPY SIGN AND RETURN TO CLERK'S OFFICE
VQUCHER NO. v 'WARRANT
ALLOWED 20
i
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Pb#
r
Board Members
EP 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 motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
1
f
Ashland Purchase Order No. 21236F
4
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))
10/15/0 92872445 payment for oil 1,889.75
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, WARRANT NO.
ALLOWED 20
A
A shland IN SUM OF
P.O. Box 116735
Atlanta, GA 30368 -6735
1,889.75
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
21236P 92872445 315 1,889.75 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
October 20 20 09
Signature
Assistant Chief of Poli
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund