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Home My WebLink About221384 07/02/2013 ±.f CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1 ONE CIVIC SQUARE AIRGAS USA,LLC CARMEL, INDIANA 46032 Po BOX 532606 CHECK AMOUNT: $52.09 ATLANTA GA 30353-2609 CHECK NUMBER: 221384 CHECK DATE: 7/2/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 9910303249 52 . 09 OTHER EXPENSES CYLINDER RENTAL INVOICE o- ®o- •-- o 0 0 1 •1 . Airgas USA,LLC INVOICE DATE PAYER INVOICE NO DUE DATE PAY THIS AMOUNT A! PO Box 9249 05/31/2013 1813998 9910303249 06/30/2013 $52.09 Marietta,GA 30065-2249 AMOUNT ENCLOSED SOLD BY AIRGAS USA, LLC s l 5430 W MORRIS ST Check INDIANAPOLIS IN 46241-3429 Credit Card 317-243-6606 Please visit www.airgas.com/onlinebilipay or complete the information on the reverse side of this form. 11^III",1111"1'1.1111 IIIn11111111'1111"Ilulllllllnlll,u,l T476 P764"AUTO 3-DIGIT 460 PL7 S296 i111�11'11"11'11"11111'1'111'Il'II'Illl"IIIII'llll'I"1111"11 BILL TO {CITY OF CARMEL SEWER 1 CIVIC SQ AIRGAS USA, LLC CARMEL IN 46032-2584 PO BOX 532609 ATLANTA GA 30353-2609 138248 18139981991030324900000052092 i TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693 ;INVOICE'NO:`_' •SOLDTO�NUMBER' >"`.SNIP.TO':.:s[ ;_s;,;;,;;;, INVOICE:DATE RENTAL PURCHASE: 'TERMS 99103032491 1813998 1778561 05/31/2013 RENT NET 30 MATERIAL/DESCRIPTION 5uBJHGT b BEG BAL SHIP-- RETURN I. ADJ END BAL LEASES NET DAY$ RATE PRICE '.DOCUMENT/DATE.:• , 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 ------------------------------------------------------------------------------=---------------------------- 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 Airgas CITY OF CARMEL SEWER www.airgas.com 130 1 STAVE SW Acct No.8,ABA o 0 Airgas USA,LLC CARMEL IN 46032-2009 PNC Bank,ABA No 031000053 i PO Box 9249 Marietta,GA 30066-2249 1.1.13 SEL-001000 Page 1 of 1 � ' VISA MASTERCARD DISCOVER AMEX Exp. mm/yy Card# Print Name Card Billing Address Card Holder's Phone Number Signature If you are faxing this form please provide your Airgas acct# and Invoice# ,from the reverse side. . . Disclosure %Ionauf Smale7 Each sale m Goods u,mm/msuvvnA/mas'"mmvonv/nonu"hoouauo,ern°uuvmotennoan«mnu/uonoonm/moisclvnum.mo Terms m Sale affixed m the Account Application(if one has boon comp/meu),and the Terms v/Sale munoat f)x(collectively the "TeRTIS of Sa'ra'). Each Contract for the sale m Goods o,ver,000between Seller and Buyer("Contract")shall inclucl�these Terms of Sale,together with any other material describing the Goods or services being sold,qieir pnce,d1divery terms,arid all other special provisions. "Goods"refers to any items of tangible personal property descfibed in any Contract m otherwise provided uv Seller mauv*r. This docurnent shows the of cylinders charged to Buyer loased to Buyer.arid which Boyer has riot returned)according to Seller's rocorris as of the month ending date showii.The,number of cylinders thus charged to Buyer sha,l be considered correct for all contractual purposes between Buyer and Seller,unless Buyer reports to Seller in writing any errors Buyer claims within 60 days aiter the date hereot. Buyer agrees to continue to pay rent on all cylinders cnar(ed to Buyer unLjI Buyer ties either(i)returned such cylinders to Seller in good working order or 1 pays Seller the reDlacement cost thereof. Refrigerant Cylinder Returns/Depo5 I, Refillable refrigerant cylinders oa/remain the property uw^o s or its third-party vendors. auol,ov'*o*rs shall not o^used»/ Customer for purposes m than the storage of gas products purchased onnA/rgvov,mummmanoreclamuoono/oontainua,*x*.n.,ofrioeraotw. s;u`mnoauic cylinder will ue subject m a cylinder deposit fee,as established by Airgas from tirne to time, Airgas will refund the deposit fee when the Customer returns,the refrigerant c�mum unless mvcr/inue/roorm/'�.`/vdoomn mue=n/o�mun,.ronp,on"/nauuv�muu.wwmxm,�mnmauo^"»oou,/�ow�mpsmv days any,menx/ode,was returned. y�o�g� m/ pwuuom, ume, uono �sa/e, cylinders and other containers / / x x�o company shall conform m the ue�nxmm m*�� published by the mm`u�mumrat+oomo�so/aanuwmm°ets .wruvunty specifications for all gas products. SELLER SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS onIMPLIED urAwuAnoa. GuAmxwrEsn. OR WARRANTIES, INCLUDING ANY WARRANTIES OF msno*AwTAamrY, pnwsnn FOR ^ PARTICULAR puepooE on NOW INFRINGEMENT AND ANY WARRANTIES THAT MAY ee ALLEGED no ARISE AoA RESULT nr CUSTOM onUSAGE. SELLER SHALL oE LIABLE ONLY FOR THE REPAIR OR REPLACEMENT OF DEFECTIVE GAS CYLINDERS AND PRODUCTS. INCLUDING THE REPLACEMENT op GASES THAT uoNOT MEET ITS PURITY appo(FIcATmwu WITH GASES THAT oo MEET SUCH SPECIFICATIONS. BUYER KNOWINGLY AND FULLY ASSUMES THE RISKS OF TRANSPORTING AND USING COMPRESSED GASES. SELLER SHALL NOT BE LIABLE FOR ANY DIRECT'EXCEPT AS EXPRESSLY PROVIDED HEREIN), INDIRECT,SPECIAL, INCIDENTAL, CONSEQUENTIAL AND/OR PUNITIVE DAMAGES,ARISING OR ALLEGED TO ARISE OUT OF OR IN CONNECTION WITH ITS PERFORMANCE OF ANY OBLIGATIONS ORANY PRODUCT,OTHER ITEMS OF SALE,OR EQUIPMENT SOLD OR LEASED BY | SELLER.WHETHER SUCH DAMAGE RESULTS FROM ANY NEGLIGENT ACT OR OMISSION OR IS RELATED TO STRICTJABILITY,OR OTHERWISE. | o,lwm.Buyer oxs/ x.,Aepawmenluo.//°o»moo days after the date ofueoeru/"w/s,, Continued open account credit is subject m Sellers assessment m Buyer's financial condition and ability lo,pay.A late payment charge of s-:4.on the unpaid,past due balance,will be assessed mmxm, (m/n/m"m two dollars'1o,on),mmrnaximum lawful aI"allowable/nmemmo where the Goods are delivered,whichever uless" | uomn notice arid receipt Of Lind enyinn documentation Buyer uxa/I patouel/e,oavm»amemmemeot of any omm^rdmaryn,emergency increases mtrecost | of(a)power andi»r raw materials used m the production nr Products anumr(u)fuel. Title to Eggipm—e-int: Title to all rental eqjipment shall remain in Seller's name. Buyer shall not cover,modify,remove or otherwise disturb any identification or other indicla of saoe,'x ownership on any rental onu.pment. Taxes: Any/a,po imposed uv federal.state,v,other governmental authority oo the sale,use o,possession ur Goods.v,the sale o'oex^,ma,c^v/`nm/oev»ra"A/rous company,shall»°paid ux Buyer/n addition m the purchase price. Iteuoized-CUaigea: (o)The total amount due from the evvr,mav/no/uuo"u,m"n itemized charges. mu/vumo: charges for,the xorux"ou/Iazxmo'm m�/er.a/,anofor compliance with wwu arid reoula/soe concerning xa,amvu"n.amria;smmmoxmrxaom/oo.uo livery arid shipping;a"um'oxv,nns for energy n. xanu(,,I the+,vrgos represent o tax n,fee paid mo''rnnn,ou uvan� ouvemme^,aumo,il�. and all of me charges are retained ov the Seller,Tie se/°r has not vnernm,./v«xa^mon the relationship between the u`amoa+.)d mr actual costs os,nr/ateu with mvc»nmeoWm"xca^vary uyvrouuu.service,umau`g place,um000mx',m`nv^. (u)w^such charges not already provided for nn Rider will xe/,pnsvu without".uua/conwnc Government Con-,racts: oonmnxirgps companies "'eo.a.government contractors and`..omn tractors and are oubliert tu and adhere m the mnuemonmo/mlJeo''^*� exumx/.wom"rs and attendant roles and muu/vwx^,o»omnoa/ly s^e3um,e Order No 11246,the nu:»um*booxct of /eraa"umo Vietnam sr�',vvtoranv naam^,*,a,, � Assistance*mm`sr«.all a*°m~ru°u_ m,naseays/oes Now doing u"onpoo with wmpv.,onmmth"n ever w,m our eaum.e^^vicumtc.oun:xwvnu/mox.vvm wstus online mua,mwexuwwwwa/mu».u,mcan z. rime and mo"o» Prescribed by State Board of Accounts Form No.301-S(Rev.1997) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount I 1 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Mo. Day Yr. Signature Title 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. /X Mo. Day Yr. ficer Title Voucher No. Warrant No. - - - ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WASTEWATER UTILITY ANOT CARMEL, INDIANA f WS Favor Of PO � y 531)(009 Ailr,, ,, GA 30353 Total Amount of Voucher $ Deductions CL- pl- 310 -O b i Amount of Warrant $ Month of Yr VOUCHER RECORD Acct.No. Collection System Pumping Treatment& Disposal Customer Accounts Administrative&General Reclaimed Water Treatment Reclaimed Water Distribution Total Allowed Board Members Filed BOYCE FORMS•SYSTEMS 1-800-382-8702 325