220051 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1
ONE CIVIC SQUARE AIRGAS USA LLC
% CARMEL, INDIANA 46032 PO BOX 532609 CHECK AMOUNT: $45.55
ATLANTA GA 30353-2609 CHECK NUMBER: 220051
CHECK DATE: 512112013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9909508069 45 . 55 CONT SVS-OTHER-S PLAN
CYLINDER RENTAL INVOICE
Airgas USA, LLC F DATE PAYER INVOICE NO, DUE DATE PAY THIS AMOUNT
Airgas. PO Box 9249 2013 1813998 9909508069 05/30/2013 $45.55
Marietta,GA 30065-2249
• • P • AMOUNT ENCLOSED
SOLD BY AIRGAS USA, LLC 15'GS
5430 W MORRIS ST Check
INDIANAPOLIS IN 46241-3429 Credit Card
317-243-6606 ase visit www.airgas.com/onlinebilipay or
plete the information on the reverse side of this form.
"'11111'1'1''III"I'I'"'I"IIII'I'll''llll'I"'ll'lll'll''lll"
T534 P846**AUTO 3-DIGIT 460 PLTO 153397 IIIIII'I'"II'""III'I'''I"'11''1'1111"11111'llll'I"IIII"I'
BILLTO (CITY OF CARMEL SEWER
1 CIVIC SQ AIRGAS USA, LLC
U'qtr CARMEL IN 46032-2584 PO BOX 532609
ATLANTA GA 30353-2609
18139981990950806900000045558
—�-�
TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOIZ QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693
INVOICE:NO: . SOLD TO NUMBER SHIP TO = 1NVOICE:DATE I RENTALPURGHASE ORQER'N0. -- TERMS
99095080691 1813998 1 1778561 04/30/2013 RENT NET 30
'MATERIAL I:DESCRIPTION ' SuB 1GT
BEG BAL SHIP RETURN Ap! END BAL LEASES NET RAYS; RATE PRICE... -
DOCUMENT/DATE.
RRCYLISM—AC — Rent Cyl Ind Small Acetylene
2 0 0 0 2 1 1 30 $0.58/DAY $17.40 N
RRCYLISM-OX - Rent Cyl Ind Small Oxygen
1 0 0 0 1 0 1 30 $0.56/DAY $16.80 N
3 0 0 0 3 $34.20
Hazmat. 11.35
Important.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the AMOUNT DUE-` $ 45.55
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
ANAI�'��S CITY OF CARMEL SEWER AIRGAS USA,LLC
N& 130 1 STAVE SW Acct No.8606074182
Airgas USA,LLC
CARMEL IN 46032-2009 PNC Bank,ABA No 031000053
PO Box 9249
Marietta,GA 30065-2249
REV 1.1.13SEL-001000 Page 1 of 1
VISA MASTERCARD DISCOVER AMEX Exp. mm/yy
Card
Print Name
�
Card Billing Address_-
CF�;l Holder's Phone Number
from the reverse side.
Disclosure
Ieoms uof Sale- Each sale m Goods o,w'°co,oyanX-gos``,-omvanvmand shall be governed bV 11re terms and conditions o^this o.savu/* the Terms ol Sale affim°A
�"'vp�c^nvn��nrnc000"oronoxasu,,'`:omva��>�z.um,��nms�au/v�"m/o/��u�umx�o�a����us�m:��co4��u���u�/mvo�',m/vmc Terms or Sale
>
s"cxuon�act for the sale of Goods n,se^'ms 1jwweensone,^ou Buyer m(�)sxao/ruuue, `*Te,moof moemor°.m any'^'r,mateoa/ the
Goods n'services being sold.their price xo/wnny temm and all other special provisions 'Gvmx'mmom any.temsu/tangible personal nr(,porl/u,-,sc,bu*.ouny000imm
o''moowim provided»y Seller/rBuyer,
This document shows t,emm:nvmoerof cylinders cna'ueum Buyer(i o. wu.uers vith ;if ue'/~,x�,sirm:da
,mmewmr,and wh.'^Buyer has nn!"etumou)according�c Seller's records ouwmomonme"u'noouteyoowo-The number uncy'ur.',s thus uhomcd a^vurp.0 *,
m.`.oereunonno'or ail,`mm,tua/vu/r'`^os'cptweenBuva/ ^,aaexer,un/e`avye-enoncms^`^-;if wmnna,vi..u�Buyer u^iw�;,',v'xo.!"v»a,^. :w,lam"*`,'
Buyer agrees m continue topvrenton�;.'oyl.rmssuhamo m Buyer until Buyer has emerr)rem^md such oyl/rCvism Seller m good wo*vnnmoor/,',`xs Sc.,'*,
'~,^cen`rn,cost'ovm`'
Rsxu umemoot ant cylinders shall remain the p;operty of Aifg:s or its mxd-v xv.enxoo
c �*e,,nnv�:xeor'ourmanma���vov/ouovmoyom,ynm000ufrom*nnsmm*sx^n`nr`mu/pmouoom:n:om gases(en n,`I.�jomu,4 m'~ e/`^��
w~x/r,*.obe^uWe�/'`acvxnoe,uopo.^fee,osvmom'xx*'/tvA.�nsvnmur�pmm`m. A/�u��..'v,000meu�z,`:�^evoe^mvu"~."e'.muns'',,^' ..,
cr,ur/un/eomow^uuer'^mnumeomaoomouwuommunreo,v.avo*tet,`'nemurmwx vvhich Jotonn.om.vn shall ue i refutable days after the cvimu"
All pnxucts, other items of aa.o, oers and otna, containers /mnoxeo by an Airgas company ,^ax coowm` to the ua`::pom thereof published »�, *,
| '.' j*oi,,m,ot the,vm'. xsp/aand w./' s000,'nr/nwm+cmoationn for u'/vuoproducts, asuEm SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS oeIMPLIED
� xnAmn«non. ouAnAwrseu. OR WARRANTIES, INCLUDING ANY WARRANTIES OF wsnCa/wrxa/Lnr r!Tmeyo FOR A *v;J,ICuLAn puRpoos on pow'
IN=RINGEMENT AND ANY WARRANTIES THAT MAY BE ALLEGED TO ARISE AS A RESULT OF CUSTOM OR USAGE.
Lr`xatau�-,f-Lmb.uu: SELLER SHALL BE LIABLE ONLY FOR THE REPAIR OR REPLACEMENI'OF DEFEC I 1,JE GAS CYIiiii!DER�AND pnuo'—',/a.WnLummo
THE REPLACEMENT or GASES rx^roo NOT MEET ITS PURITY apeumo«rmwnWITH GASES THAT oo MEET SUCH yPr/3/rn*r'nnm auvsnxw*^"wcc'
� puux �p�'��� `�*px+uxs '� rn�wspon�/wu,`^'ous'wscrwpnssssom�sc� ssurns�'' . '�` ~ � � �'. ` .
eu'ncsyc/ ppO'vmmyEnow). mb.oEcT,SPECIAL, INCIDENTAL,unwacouswnALwwonpummv., +`";.''' z, 1 -�� �/.r ` `
OF OR IN CONNECT10«WITH ITS PERFORMANCE OF ANY OBLIGATIONS CRANY PRODUCT.OTHER ITEMS OF SALE,OP EQUIP1,1EXT S�kD OR Ls^sso �,
oeusx.WHETHER S,-'CH DAMAGF RESULTS FROM AN Y NEGLIGENT AcT OR OMISSION CR IS RELATED—)STRICT L i�BiL!T,OR CTHER,,^SE
/ Ti�,o,s of Pa,/merit, Unless otlber-.°;se SD^crfied il a Contract,Buyer shall make payrient in full within 30 days after the date.of Se;Ie-3 invc/�e. conm"od anon account credit
| �son'^,�```��p~to/o^�'mnnmum'�omo*'.and au//uvw/`'vx/,�psvmen�u,".nom � s� `,.^oounna/u�p^s`ouo~a�ao'm �n����o`^+o"`m�/v
^ ,./..'s �),It,n^^',m, ma m*,slotc.vnmm the Goods o^..^wen^,m.m",ypless
u,,LUu�s' uri. ,.*. ,nu m::("pt')-, a u= l�w1f'Seller,~mc z:lemr�evo.: ,f"xvaxtraar/*m v°m*neocy.."sae�,m the,,)s�
mja/wwe,*m,.)im*,ntenaio used� ., ro jc^m wrmxomsa"um,m/'ow.
a:orta/eq. o`e'tyxal/rpfmar~Seller�naw^ ovve,shall nn�uo,er nx*vvemo ~ornmerwmooisturlb.n,menllfirat'o`�rome ./m�"ao'
oe��vnnv� ,o,*'�.u`:e--'qw.vran/
�i� .',vtam,, urIr-,oem,^ ^arAlter o-itiwr/' .if the sale,use mn�-essio of (if 'ho sale*,s�nrnmnce of »(,,s c'all ar,j&~
cw),Ipaov shall uepambysL;yermvd*mmmme purchase p*e-
C&��u� (n`-xomu|am"`"� uoe`,umm�ou/"' nmvmwvo*q.mv, �m/za� rx��*`. mc/.,mnu. :.a�esm,mehuno'`3^'xaz^m' ` 'r`'~`x`�,�
vm,.*u,u,w/u� av*v"u regulations coocon',ohan,;rdo"s-nter.p/n:cxomo`m,'y,m/inm,u��.�and sh.p;'nn:aoom'cxvrci,s for'.`, n''/,
~.--)sr/a tax .x fee vp:dmcrmv�^ (� xvm'uuflr,.n"' amova' a` all m the charges are em-ed »v'he Selle The n*/wha` ~/�`�. �
.,Jxorg'aam:` ,,u^" mye 'mwm the i, sh«h'Lo,z ,Product,mrxo,,vnv"cJ %
oo,'ywfxman:,*vmbe.rrnsx without.wm, consent
r�`�1-,�' a,' L F, !' *''.mn,'z"'°^`,^'* o,.r�x°'
,,j Executiv,, i-lrdcr xu e*,�,:`�,' ~.
Airgas nBwv/"m"
'`°doumbusjnus`wo`A,m���s.,:�� thareverwith ou,e6"���sil,�.xttp://=ww.v/ogas.com. Visit w online today to see/r)%v www.ai,gas.xoni can sa�e`�
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 5/14/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/14/2013 9909508069 $45.55
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
VOUCHER # 135539 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
9909508069 01-7362-06 $45.55
Voucher Total $45.55
Cost distribution ledger classification if
claim paid under vehicle highway fund