214578 11/20/2012 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
oar? CHICAGO IL 60686 CHECK NUMBER: 214578
CHECK DATE: 11/20/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 323264 4, 525 . 00 OTHER EXPENSES
BRENNTAG AWK
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
[NVOICE#: BMS323264 INV DATE: 11/05/12 * PAGE 1 OF 1 * *
DUE DATE: 12/05/12
SOLD TO: SHIP TO:
CARMEL WASTE WATER CARMEL WATER, PLANT 5
3450 WEST 131ST STREET 5484 E . 126TH STREET
CARMEL IN 46074 CARMEL IN 46032
FEDERAL ID #: 610504545 DATE SHIPPED: 11/05/12 TERMS NET 30 DAYS
3/L #. . . . 124977-00 SHIP WHS : 29 SALESPRSN: 294
:USTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG
:USTOMER PO#: JERRY FOB . . : DELIVERED
TAX EX# : 356000972-001-9
JNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED
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80 .0000 805002 1 . 000 4000 .0000# 1 . 1250 4, 500 .00
50 .0000 # BAG SOD FLUORIDE GRAN
>A F/S
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JESTIONS, CALL 317-898-8632
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REMIT TO ADDRESS :
BRENNTAG MID-SOUTH, INC
3796 RELIABLE PARKWAY
CHICAGO IL 60686-0037 * MERCHANDISE 4, 500 .00
INS & SEC SURCHARGE 25 .00
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PAID ON OR PRIOR TO 12/05/12 INVOICE TOTAL USD 4,525 .00
PAID AFTER 12/05/12 INVOICE TOTAL USD 4,615 .50
Original Document
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VOUCHER # 122725 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
323264 01-6180-03 $4,525.00
Voucher Total $4,525.00
Cost distribution ledger classification if
claim paid under 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 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 11/12/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/12/201, 323264 $4,525.00
1 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
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Date Officer