218372 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1
` ONE CIVIC SQUARE AIRGAS USA,LLC CHECK AMOUNT: $43.27
CARMEL, INDIANA 46032 Po Box 532609
' ATLANTA GA 30353-2609 CHECK NUMBER: 218372
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9907796381 43 .27 OTHER EXPENSES
CYLINDER RENTAL INVOICE
o- ®®- o-- 0 0 0 ® •1 .
Airgas USA,LLC INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT
A! PO Box 9249 02/28/2013 1813998 9907796381 03/3012013 $43.27
Marietta,GA 30065-2249
0 0 o AMOUNT ENCLOSED
SOLDBY AIRGAS USA, LLC
❑ Check
5430 W MORRIS ST
INDIANAPOLIS IN 46241-3429 ❑Credit Card
317-243-6606 Please visit www.airgas.com/onlinebillpay or
complete the information on the reverse side of this form.
"'11111'1'1'1111"I'I'"'1"1111'I'll''llll'I"'ll'lll'11''lll"
T450 P743"AUTO 3-DIGIT 460 PLTO 127768 II I I I I P--1 'I
.I I._ I '1 11
BILL TO {CITY OF CARMEL SEWER 1 111 1 Ir i'llll"Illlrun'I"IIII"I
1 CIVIC SQ AIRGAS USA, LLC
CARMEL IN 46032-2584 PO BOX 532609
ATLANTA GA 30353-2609
18139981990779638100000043275
TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON-Y OUR ACCOUNT PLEASE CALL: 800-727-0693
INVOICE N0. SOLD l O NUMBER SHIP TO INVOICE DATE RENTAL PURCHASE ORDER NO. TERMS
99077963811 1813998 1778561 02/28/2013 RENT NET 30
MATERIAL/DESCRIPTION suB�ECr
BEG BALI SHIP RETURN AD,1 END BAL LEASES
NET DAYS RATE -. .< PRICE :.
DOCUMENT/DATE To RENT
RRCYLISM—AC — Rent Cyl Ind Small Acetylene
2 0 0 0 2 1 1 28 $0.58/DAY $16.24 N
RRCYLISM—OX — Rent Cyl Ind Small Oxygen
1 0 0 0 1 0 1 28 $0.56/DAY $15.68 N
-------------------------------3-----0 0 0 3 $31.92
Hazmat: 11.35
Important.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the AMOUNT DUE $ 43.27
Reverse side of this form.You will be deemed to have accepted the provisions in the said
Notice as part of the contractual arrangements between you and us,unless you reject such
provisions by written advice to us within(15)days after the date of this document.
SHIP TO:1778561
6� CITY OF CARMEL SEWER AIRGAS USA, LLC
irg s. www.airgas.com 130 1 STAVE SW ACT. A ,ABA NO.
Airgas USA, LLC
CARMEL IN 46032-2009 PNC BANK,ABA NO. 031000053
PO Box 9249
Marietta,GA 30065-2249
Page 1 of 1
CREDIT CARD BOLLING
VISA MASTERCARD DISCOVER AMEX Exp. mm/yy__
Card#
Print Name
Card Holder's Phone Number
If you are faxing this form please provide your Airgas acct# and Invoice#
trom the reverse side.
Disclosure
]�-.mle«Sa�e: Each sale cf Goods mservi,"n��XrgFs'�'� is and shiri/» al�«ed
/u/"e ,��(;ompt Apt xzm^^,f/�une has bvvncm`,n/emu),a rid o`oTcno,a/Salo tououa/
s�'.rm�mufor the sale mGo,,ids orser,;ce�;between Sei.er^nd Buver("Contract')shall include those Terms wSale, uietvqit�i .n.ite a!== 11,�
�uvcmmrv,cos uc'n"Ca,mu,prv:�� o�/wery forms,o,ov/^noy special provision,,:, Tovus"m�r.�;m any,loxq oft��,n:uenemonm 'lesua��
j�m'o,,�vis nrov;deri by,zeiler wBuvw
/v�do�n�nw` mw�� a �^m�a ha ``��unu
/omuvc�"ov�'.'ouwmrous'w'x`uo`ao�om*mmqw�o,u,x�u omoy�o`amonu/onn'o:oasnman 'o, mm'uo,o,q/"u,,,mc*�`omwt.^ �.
�,n,'ir,,v'oo;,erura''mntructw/purposes between Buyer mm Seller,unless svva anry n 60(Iny",ao~ F reo
a',Y,.'oume m��n,m:o�o pay rent oosx*^''oomo^o�ov^.nuvorvomovrx^uevxour(o"�un,oa.m`��//m�'x�'a*'/�/000vu�r,;^, u.ou-u,ffc,~,` So; if?,,
w�n�v=tms �e.e�
Ee[,,g e,Pi".1 G,I 1,o,I RefilLOlo refrigerart Cyl!Liers shall remain the property of Airgai,or its th;,d-pariy vendors, Such cyl:wle.,,shall not�)e
cust"mer for purposes oihor than the sv),ei,f of gas products,OCrclhased f'ron,Alr(as or 1,he return ard tociamation of 11 . k ;
cy ,n;ess the cykridur's condition j��dee,ned tc be until to,,muse,as rietemic'!d 1�y Airgas.whict�det'errmnation sha;"!,�� nefut'abie s-xby�,.�zys aftcr 1he
M°
All pfoducts, f1hor Jerns of c0incers and olher containers run /�� b� n:e
'w'`unzera the'n�mc;au arid v`,w,,�t Seller's o�CuwMsANY nTxsnExpmEcx'`°/mpuso
arAwoxnm� aoAnAmrcea. OR WARRANTIES, /mcLumwnANY wwxnAwr/saop msacxAwrxauITY, rnxsSS FOR mpwR`�i pun''.�,' o!R NON-
INFRINGEMENT AND ANY WARRANTIES THAT MAY BE ALLEGED TO ARISE AS A RESULT OF C USTOM OR USAGE"
L.m/..^xn/uac.'.w SELLER SHALL BF LIABLE ONLY FOR THE REPAIR OR REPLACEMENT OF DEFEii �AS CYLINDER/ PROD!I��
Th('."EPLACEMENT OF GASES THAT DO NOT MEET ITS PURITY SPECIFICATIONS WITH GASES THAT DO M�ETSUCH SPECIFI(,`i`,-I;0NS. au,� '��'w/wmu
AND FULLY ASSUMES THE nmasopTRANSPORTING AND USING compeeosso GASES. ssusweoAuNOT BeuABLs `nn ANY o/neo '':,C,sprAs
EXPRESSLY PROVIDED*snem). INDIRECT, SPECIAL, INCIDENTAL,oomapnusmnAL AmomR PUNITIVE DAMAGES,ARISING On ALLEGED To,ARISE our
OF OR IN CONNECTION WITH ITS PERFORMANCE OF ANY OBLIGATIONS ORANY PRODUCT.OTHER ITEMS OF SALE.OR EQUIPMENT SOLD()F7 `-,AsED BY
SELLER,WHETHER SUCH DAMAGE RESULTS FROM ANY wsGueswrAuroR OMISSION on/mnctxrco����rn/uruxno�/r, anorxcnw'�-
oo`*.*/sosp''m/.x.i"o Contract,o"�°. shall m"kevv/.n,"/m full wumn»o,.vvx after+v.^ '`/Seller's inv�,/r, c',cu..v/.d'`p., C,:/
"a�euwsoo*'^ysv^.�n*mot Buyer�vnaocio/condition oou ability m /a'a payment oo of 1.syonmt: :/nou,past uuo,z'ire.waoe mn,th/v
«wuvmz(1S.)/�)"m the rilon.rmm;awfu/ratox/m*xm"in the staic!wwn[no Goods a^.uu�;veisu.whic* less.
Upon nolcc«m receipt ofom°,:yo Buyer shall/uYw Seller axmohanp.`mevven`oFm/emnaoluin«y., w°,uvncv in./wcosL
of mi power*odlu m*",-A*nala used m the production ofpm"(icts and/or(b)fuel
�u � ''� � x I
^e,c,' ownership or,o,/ro"ta'uqu/pn'*it,
Ia mw�xm+o*m.o/louem om!o.wothrnovemns`m'uuuwmyonowwa use orncs,uss;omofGoo( 'ho sale m mx'"^�' �., unx.:il',
oxp:bwo^'owBuvo/ m addition umenumxuo*u"oo,
w7`euxv/omoun'o'/e/nm the evver may include.vui tem/u,uxxarq^s, 'o,!L�u/no: mmc^- to, ,he"a*o,:.,, znd�u.
^m�/m`covmx/avvs,"u��uotmnozro,n,:nnmaz,mv"o���nnw�um�uxurm,r�o.m�uoo,��swx^�m.��m�/`��mn�um,^`u.�p�uo'.n�`
.=,(.or^s tax m fee paid mmimposoQ 1)ymngovernmen�ouhority.and 7.11 -,1 charges a, yoned by/!ip nhe,eelip. apecm n-t�fsumo
rci,loc^,m/nuetw* nmu`amo o"umyocua/omuv�ocou��mmu�rmma w;/m can vo�u'oumv,t.s*w',c time and n;o"u, °ucv
oxo'»,uc^�vmsuvpn,,demuxman��w/ bm/nnoom/vvu'^utmvmmum^^nt.
oewmxircj" u,rpaniev are ua.j.^w.imexomriw,"sa,id.wmxm/m:w^and ate ebjIw�`"ra,dx^wc0./,qu"e.cmW,,. '.'�.,,:w�
',c�'L,oveordao apo"xnumtmIcs and muvlatono.spnc,.J^�*Execuwrom^ Nu� 11246.mex�eu"ltaunn Az/.' e!3 and tt,e wo:'` Em Veto-a", '`.',Jusxmxw
^osi,mum Act of 1974,mssamended.
mmaseeus/"ess
no°""-o,usm=mw'i:.wrgns/,easier p"-ever with our oauymoyeweuxxe, ht*p:xwwwa/r9os.o^m Visit us nuoxmsee www.o/was.con. �u,,vu,
VOUCHER # 135125 WARRANT # ALLOWED
355856 IN SUM OF $
AIRGAS USA, LLC
PO BOX 532609
ATLANTA, GA 30353-2609
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9907796381 01-7362-06 $43.27
Voucher Total $43.27
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
355856
AIRGAS USA, LLC Purchase Order No.
PO BOX 532609 Terms
ATLANTA, GA 30353-2609 Due Date 3/18/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/18/2013 9907796381 $43.27
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