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Home My WebLink About173717 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 358405 Page T of 1 ONE CIVEC SQUARE ASHLAND SPECIALTY CHEMICALS CARMEL, INDIANA 46032 P 0 BOX 116735 CHECK AMOUNT: $758.11 ATLANTA GA 30368.6735 CHECK NUMBER: 173717 CHECK DATE: 6/24/2009 DEPAR ACCO PO NUMBER INVOICE NUMBE AMOUNT DESCRIPTION 1110 4231500 21025 92512891 758.11 OIL �S�rIL�NUm REMITTANCE ADVICE ORIGINAL t' Page 1(1) Invoice Number Invoice Date Due Date 92512891 28 May 2009 27 Jun 2009 P.O.Number Payment Terms Payer Number N 05/2212009 Net 30 Days 344796 ri rn 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 1800848 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 Oty UoM Unit Price Amount Number USD 2 DR UM741 ULTRAMAX 5W30 DR 55 GA 2 DR 376.9150 753 -83 Fuel /EnergySurcharge 4.28 Should you have any questions regarding this Invoice Total invoice, please contact USD 758.11 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 Number0968468 Account Number40502427 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 29 May 2009 visit us at www.ashiand.com 0 INDIANA RETAIL TAX EXEMPT PAGE II Carmel CERTIFICATE NO. 003120155 002 0 f +T., JL PURCHASE ORDER NUMBER PoUce Depa FEDERAL EXCISE TAX EXEMPT 21025 35- 60600972 3 ONE' 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 REOUISITION NO. VENDOR NO. DESCRIPTION Tune 2009 oil VENDOR Ashland SHIP City of Carmel Police Department P.O. Box 116735 TO 3 Civic Square Atlanta, AAA 30368 --6735 Carml, IN 46032 CONFIRMATION BLANKET CpNTRACT PAYMENTTERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRIGS EXTENSION 2 55 gall &n drums of oil 376.91 753.83 T 1 0 All e Send Invoice To: PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT 1110 3 coil PAYMENT 3 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 PROP SWORN SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS I HEREBY CERTIFY IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SU TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. �j� THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE A ss i tant Chief of Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO. VP. V. COPY -SIGN AND RETURN TO CLERK'S OFFICE V01 UCHER NO. WARRAN i NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEFT. 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 A shland Purchase Order No. 21025F P .O. Box 116735 Terms A tlanta, GA 30368 -6735 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5/28/09 92512891 payment for oil 758.11 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 VO J JCHER NO. WARRANT NO. ALLOWED 20 i A shland IN SUM OF P.O. Box 116735 Atlanta, GA 30368 -6735 758.11 ON ACCOUNT OF APPROPRIATION FOR policedgeneral fund Board Members Po# or INVOICE NO. ACCT /TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 21025F 92512891 315 758.11 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 June 17 2009 Signature Chief of Police Cost distribution ledger classification if Title claim paid motor vehicle highway fund