176655 09/02/2009 CITY OF CARMEL, INDIANA VENDOR: 358405 Page 1 of 1
ONE CIVIC SQUARE ASHLAND SPECIALTY CHEMICALS
i CHECK AMOUNT: $758.87
CARMEL, INDIANA 46032 P O BOX 116735
a� �o, ATLANTA GA 30368 6735 CHECK NUMBER: 176655
CHECK DATE: 9/2/2009
DEPAR ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
,110 4231500 21077 92711121 758.87 OIL
REMITTANCE ADVICE ORIGINAL
i Page 1(1)
Invoice Number Ioice Date Due Date
92711121 3 Aug 2009 12 Sep 2009
P.O.Number rN.1Y11 ament Terms Payer Number
phone Jason Days 344796
r-1
Shipped From Carrier Bill -To Number
NOBLESVILLE HERRIMAN BLVD PKGD ASHLAND FLEET INDIANAPOLIS 15280 344796
Bill of Lading Number Incoterms DDP Dest, Frt Prepaid Ship -To Number
1954869 344796
Billing address Shipping address
CARMEL POLICE DEPARTMENT CARMEL POLICE DEPARTMENT
3 CIVIC SO 3 CIVIC SO
CARMEL IN 46032 -2584 CARMEL IN 46032 -2584
Qty. UOM Material Number Material Description Batch Billing Qty UoM Unit Price Amount
Number USD
2 DR UM741 ULTRAMAX 5W30 DR 55 GA 2 DR 376.9150 753.83
Fuel /EnergySurcharge 5.04
Should you have any questions regarding this Invoice Total
invoice, please contact USD 758.87
ROBIN GOOLMAN
at 859 357 -2318
Remit to ACH Credit Wire transfer
P.O. Box 116735 Ashland Inc. Ashland Inc.
ATLANTA GA 30368 -6735 Account Nurnber:0968468 Account Number:40502427
Mellon Bk 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:
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 14 Aug 2009
visit us at www.ashiand.com
i INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO. 003120155 002 0
C JL C a Ji PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 91077
3 qRR CIVIC 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
!<!ll t 13, Qt Oil
VENDOR Asill.and SHIP City of Carmel Maintenance Facility
P.O. Box 1.16735 TO 3400 W. 131i;t Street
A GA 30368 Westfield, IN 46074
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
2 55 gallon drums of oil 379.41 758.82
Send Invoice To: f
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 315 oil PAYMENT
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 AFFIDAVITATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C I 'l l te C. O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY /1�
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. y7, G
THIS ORDER ISSUED IN COMPLIANCE. WITH CHAPTER 99, ACTS 1945 TITLE Chief of Pol ice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO A•P. COPY- SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. NO.
v
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# 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
Ashland Purchase Order No. 21077F
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))
8/13/09 92711121 payment for 2 55 gallons drums of oil 758.87
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
kshland
IN SUM OF
P.Q. BQx 116735
Atlanta, GA 30368 -6735
758.87
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
21077F 92711121 315 758':87 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
August 25 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund