215981 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 359584 Page 1 of 1
1 ONE CIVIC SQUARE BRENNTAG MID SOUTH INC
®.o CARMEL, INDIANA 46032 3796 RELIABLE PARKWAY CHECK AMOUNT: $660.00
CHICAGO IL 60686 CHECK NUMBER: 215981
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 BMS341123 660 . 00 OTHER EXPENSES
BRENNTAG
BRENNTAG MID-SOUTH, INC.
1405 HIGHWAY 136 WEST
PO BOX 20
HENDERSON KY 42419-0020
INVOICE#: BMS341123 INV DATE : 12/10/12 ** PAGE 1 OF 1 ***
DUE DATE: 1/09/13
SOLD TO: SHIP TO:
CITY OF CARMEL UTILITIES CARMEL WATER, PLANT 4
3450 WEST 131ST STREET 10675 N. GRAY ROAD
CARMEL IN 46074 CARMEL IN 46032
FEDERAL ID #: 610504545 DATE SHIPPED: 12/10/12 TERMS NET 30 DAYS
B/L #. . 149818-00 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
--------------------------------------------------------------------------------
1 .0000 253418 11 . 870 2000 . 0000# . 2650 530 .00
2000 . 0000 ## CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
--------------------------------------------------------------------------------
2.0000 873311 11 .870 300 .0000# . 3500 105 .00
150.0000 # CYL CHLORINE, LIQUID (BMS ONLY)
>A RPK
--------------------------------------------------------------------------------
QUESTIONS, CALL 317-898-8632
* REMIT TO ADDRESS :
BRENNTAG MID-SOUTH, INC
3796 RELIABLE PARKWAY
* CHICAGO IL 60686-0037 * MERCHANDISE 635 .00
INS & SEC SURCHARGE 25 .00
PAID ON OR PRIOR TO 1/09/13 INVOICE TOTAL USD 660 . 00
PAID AFTER 1/09/13 INVOICE TOTAL USD 673 . 20
Original Document
?U
VOUCHER # 123130 WARRANT # ALLOWED
359584 IN SUM OF $
BRENNTAG MID-SOUTH INC
3796 RELIABLE PARKWAY
CHICAGO, IL 60686-0037
Carmel Water Utility
ON ACC NT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
i
341123 01-6180-03 $660.00
Voucher Total $660.00
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 12/29/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/29/201; 341123 $660.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer