215583 12/18/2012 f CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
ONE CIVIC SQUARE BRENNTAG MID SOUTH INC CHECK AMOUNT: $555.00
` CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY
CHICAGO IL 60666 CHECK NUMBER: 215583
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 BMS338866 555 . 00 OTHER EXPENSES
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
INVOICE#: BMS338866 INV DATE: 12/05/12 *** PAGE 1 OF 1 *
DUE DATE: 1/04/13
SOLD TO: SHIP TO:
CARMEL WASTE WATER CARMEL WASTE WATER
760 3RD AVENUE 9609 N. RIVER ROAD
S.W SUITE 110 CARMEL IN 46280
CARMEL IN 46032
FEDERAL ID #: 610504545 DATE SHIPPED: 12/05/12 TERMS . :- NET 30 DAYS
B/L #. . . . . 146821-00 SHIP WHS : 29 SALESPRSN: 294
CUSTOMER # . : 407542 SHIP VIA: OUR TRUCK - PKG
CUSTOMER PO#: 513412 FOB . . : DELIVERED
TAX EX# : 356000972-001-9
UNITS SHIPPED PROD # WGT/GAL TOTAL QTY UNIT PRICE EXTENDED
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PLEASE PICK UP EMPTIES
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1 .0000 253418 11 .870 2000.0000# .2650 530.00
2000.0000 # CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
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QUESTIONS, CALL 317-898-8632
* REMIT TO ADDRESS:
* BRENNTAG MID-SOUTH, INC
3796 RELIABLE PARKWAY
* CHICAGO IL 60686-0037 * MERCHANDISE 530.00
INS & SEC SURCHARGE 25.00
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PAID ON OR PRIOR TO 1/04/13 INVOICE TOTAL USD 555.00
PAID AFTER 1/04/13 INVOICE TOTAL USD 566. 10
Original Document
i
VOUCHER # 126342 WARRANT # ALLOWED
359584 IN SUM OF $
BRENNTAG (ULRICH)
3796 Reliable Parkway
CHICAGO, IL 60686
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
BMS338866 01-7182-05 $555.00
Voucher Total $555.00
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 (ULRICH) Purchase Order No.
3796 Reliable Parkway Terms
CHICAGO, IL 60686 Due Date 12/12/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/12/201: BMS338866 $555.00
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
Date Officer