HomeMy WebLinkAbout219206 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1
} ONE CIVIC SQUARE AIRGAS USA,LLC
CARMEL, INDIANA 46032 PO BOX 532609 CHECK AMOUNT: $52.09
ATLANTA GA 30353-2609
„o„ o CHECK NUMBER: 219206
CHECK DATE: 4/2412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9908725527 52 . 09 OTHER EXPENSES
CYLINDER RENTAL INVOICE
Airgas USA, LLC INVOICE DATE PAYER INVOICE NO DUE DATE PAY THIS AMOUNT
A! . PO Box 9249 03/31/2013 1813998 9908725527 04/30/2013 $52.09
Marietta,GA 30065-2249
• • 0 • AMOUNT ENCLOSED
SOLD BY AIRGAS USA, LLC ❑ Check 001
5430 W MORRIS ST
INDIANAPOLIS IN 46241-3429 ❑Credit Card
317-243-6606 Please visit www.airgas.com/onlinebilipay or
complete the information on the reverse side of this form.
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BILL TO {CITY OF CARMEL SEWER
1 CIVIC SQ AIRGAS USA, LLC
CARMEL IN 46032-2584 PO BOX 532609
ATLANTA GA 30353-2609
18139981990872552700000052097
TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693
INVOICE N0: SE}LD:TO NUMBER SHtPTO INVOICE DATE RENTAL,PURGHASE OR ERNE?. .:.TERMS
9908725527 1813998 1778561 03/31/2013 RENT NET 30
MATERIAL OESC,RfPTION 5u8JECT
131 G't3Al SHI P: RETURN ADJ ENRBAL kEASES NET DAYS .: RATE PRICE
tlpGtfMENT/DATI :. :TO.RENT-
RRCYLISM-AC - Rent Cyl Ind Small Acetylene
2 0 0 0 2 1 1 31 $0.58/DAY $17.98 N
RRCYLISM-OX - Rent Cyl Ind Small Oxygen
1 0 0 0 1 0 1 31 $0.56/DAY $17.36 N
------------------------------------------------------------------ ----------- ------ -
3 0 0 0 3 $35.34
0 ). '-7 3 b,;). 0
Hazmat: 16.75
Important.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the AMOUNT DUE::: $ 52.09
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 AIRGAS USA,LLC
ors. CITY OF CARMEL SEWER ACT.NO.8606074182
www.airgas.com 130 1ST AVE SW PNC BANK,ABA NO.031000053
Airgas USA,LLC CARMEL IN 46032-2009
PO Box 9249
Marietta,GA 30065-2249
REV 1.1.13
SE 01000 Page 1 of 1
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VOUCHER # 135329 WARRANT# ALLOWED
35,5856 \ 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
9908725527 01-7362-06 $52.09
Voucher Total $52.09
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 4/16/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/16/2013 9908725527 $52.09
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