206978 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $4,525.00
CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY
CHICAGO IL 60686 CHECK NUMBER: 206978
CHECK DATE: 3/13/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 171849 4,525.00 OTHER EXPENSES
BRENNTAG
BRENNTAG MID SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419 -0020
INVOICE BMS171849 INV DATE: 2/29/12 PAGE 1 OF 1
DUE DATE: 3/30/12
SOLD TO: SHIP TO:
CITY OF CARMEL UTILITIES CARMEL WATER, PLANT 5
3450 WEST 131ST STREET 5484 E. 126TH STREET
CARMEL IN 46074 CARMEL IN 46032
416 x'651
FEDERAL ID 610504545 DATE SHIPPED: 2/29/12 TERMS NET 30 DAYS
B/L 920853 -00 SHIP WHS: 29 SALESPRSN: 294
CUSTOMER 407542 SHIP VIA: OUR TRUCK PKG
CUSTOMER PO JERRY FOB DELIVERED
TAX EX# 356000972 -001 -9
UNITS SHIPPED PROD WGT /GAL TOTAL QTY UNIT PRICE EXTENDED
80.0000 805002 1.000 4000.0000# 1.1250 4,500.00
50.0000 BAG SOD FLUORIDE GRAN
>A F/S
QUESTIONS, CALL 317- 898 -8632
REMIT TO ADDRESS:
BRENNTAG MID SOUTH, INC
3796 RELIABLE PARKWAY
CHICAGO IL 60686 -0037 MERCHANDISE 4,500.00
INS SEC SURCHARGE 25.00
PAID ON OR PRIOR TO 3/30/12 INVOICE TOTAL 4,525.00
PAID AFTER 3/30/12 INVOICE TOTAL 4,615.50
Original Document
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
359584
BRENNTAG MID -SOUTH INC Purchase Order No.
3796 RELIABLE PARKWAY Terms
CHICAGO, IL 60686 -0037 Due Date 3/5/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/5/2012 171849 $4,525.00
a
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
.3 L (c L. 'ma, lzv
Date Officer
VOUCHER 113913 WARRANT ALLOWED
359584 IN SUM OF
BRENNTAG MID -SOUTH INC
3796 RELIABLE PARKWAY
CHICAGO, IL 60686 -0037
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
171849 01- 6180 -03 $4,525.00
Voucher Total $4,525.00
Cost distribution ledger classification if
claim paid under vehicle highway fund