222298 07/30/2013 CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1
0 ONE CIVIC SQUARE AIRGAS USA, LLC CHECK AMOUNT: $52.89
' CARMEL, INDIANA 46032 PO BOX 532609
ATLANTA GA 30353-2609 CHECK NUMBER: 222298
CHECK DATE: 7/30/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9910971999 52 . 89 OTHER EXPENSES
CYLIN DER RENTAL INVOICE
•- o.- !98 • e •o .Aas USA,LLC INVOICE DATE PAINVOICE NO. DUE DATE PAY THIS AMOUNT
Airgas. PO Box 9249 06/30/2013 181 9910971999 07/30/2013 $ 52.89
Marietta,GA 30065-2249
. • , e AMOUNT ENCLOSED
SOLD BY AIRGAS USA, LLC Ja
❑ Check
5430 W MORRIS ST
INDIANAPOLIS IN 46241-3429 F] Credit Card
317-243-6606 Please visit www.airgas.com/onlinebillpay or
complete the information on the reverse side of this form.
IIII...I�JIII'1111....IIIIIIIIIIIILII��IIII�JIIII��I,�I�L„11
T481 **AUTO 3-DIGIT 460 PL8 S296
BILL TO
{CITY OF CARMEL SEWER II I'I ' II III I I II I IIII IIIII IIIIIIIII"I
1 CIVIC SQ AIRGAS USA, LLC
111. CARMEL IN 46032-2584 PO BOX 532609
M6 ATLANTA GA 30353-2609
138315
18139981991097199900000052897
TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORT'l ON WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727 4693
INVOICE NO. SOLD'•TO NUMBER "$HIP TO.? INVOICE DATE RENTAL.PURCHASE ORDER NO. TERMS'
99109719991 1813998 1778561 06/30/2013 RENT NET 30
-MATERIAL I DESCRIPTION SUBJECT
BEG BAt - _BRIE RETURN Apd END BAC LE_A_5ES - NET DAYS. RATE ,F - ' PRICE
DOCUMENT/DATE:
TO:RENT
RRCYLISM-AC - Rent Cyl Ind Small Acetylene
2 0 0 0 2 1 1 30 $0.6148/DAY $18.44 N
RRCYLISM-OX - Rent Cyl Ind Small Oxygen
1 0 0 0 1 0 1 30 $0.59/DAY $17.70 N
==============------------=-=3 0 0 0 3 $36.14
0�
Hazmat: 16.75
Imaortant.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the AMOUNT:7 $ 52.89
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
CITY OF CARMEL SEWER AIRGAS USA, LLC
Airgas. g 130 1 ST AVE SW Acct No. k,ABA4 o 0
www.air as.com PNC Bank,ABA No 031000053
Airgas USA,LLC CARMEL IN 46032-2009
PO Box 9249
Marietta,GA 30065-2249
Page 1 of 1
SEL-001000
VISA MASTERCARD DISCOVER AMEX Exp. mm/yy
Card #
Print Name
Card Billing Address
lCard Holder's Phone Number
IV vou are faxing this form please provide your Airgas acct# and Invoice#
tfi,om the reverse side.
Disclosure
]eois of Sale- Ea:,,h sq.e of Goo,is or serv:ces by an Airg as 1"company is and shall be cover neo by tile terms and conditions on this Disclosure,the Ternis of Sale affixed
w the Account Amyva"on/if one rpSve*^oump'etou),and the Terms m Sale found ot 11 ��gcuuuou�axn �m,n°ou,v/vmv^�nn,�onur>
m"xcno;m.,/^.the sale o/oon,r".so-vices u*twoon Seller and Buyer rco^trau'>oha//."'a/ua these Terms o/Sale.together with any other u/eoa/describing the
Goods rra,rv/p°a:)e/np sold,their v,i^o.ce:vex terms,and all other onoom'nm,/mms. "Goods"refers m any items m tangible v*000a�property described m any Contract
vro?henwmern`m~o'u'Seller!c Buve.,
Notice Regarding Cylinder RentaisiLeases and Resnonstbility: This diCUomnt shows the lom�number of cylinders charged mu��ya,�m�swu���x��m��
.ev�uwows,un«which Buyer x"�^m�mneu>x�r�nomaoov,o'w*�xa,ofm*mrmhonu/ o � / n" be m /
Buyer o ou
u,o,meredmno-A'c,all contractual v"poses between oApr and Seiler,v"/*sn Buyer reports m Seller mwriting any errors Buyer claims within eo days after the date hereof.
suve,agrees wm-o,upmpay or.all cylinders charged m Buyer until Buyer has a.merW returned Such,cylinders m Seller m good working order^,(m pays oonv,om
ep/aceMem cos,me/^wf.
Refrigerant Refillable cylinders o remain the property,xmrgasmxsu`/,a-v"rty vendors. nucxov:ndom shall riot be used uv
Customer for purposes other mnr/�e storage of gas products purchased fioin Airgas or the retum and reclamation of certain gases(e.g.,refrigerants), Each refillable
cylinder will uasubje�;tma cyiiridnr./,no,uue.ouecwma:ouuvmmaso"nnmemuals. xov;wioremnumeuenositmowhe,meoustome returns the refrigerant
c�/nm�unless�o:/onuersm^lmuo/oueeme wuo^nm�/evm`.e,d�pon/^vuuvA/may'wmu`oe�^n.nat'm`shnooe/nommmon��days after m~uvxrmo/was
nyvmau.
Warrantv A!' ,nmuow, n'ne, ue=s of sale, udina,u and mh°rov.,mmo,�s fum/vxeo "v n"mmas company oxnn conform tom* description thereof published by the
.nanvmomre,:�t t"atime m sale and will meet ue/e,'o purity opociooaon"u for all gas pmd..r!s SELLER SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS onIMPLIED
uTxmoxnoo, ouAnAwrsEo, OR wwnnAwnsa, INCLUDING ANY WARRANTIES OF meno*Awn^amrY, pnwsas FOR APARTICULAR punpoos on NOW
INFRINGEMENT AND ANY WARRANTIES Tx^TMxvBc ALLEGED/oARISE AoA RESULT op CUSTOM oRUSAGE.
SELLER s4xLLosuAe4+ONLY FOR THE PEPAIR OR REPLACEMENT OF DEFECTIVE GAS CYLINDERS AND PRODUCTS. INCLUDING
THE REPLAGEMENT OF GASES THAT DO NOT MFET ITS PURITY SPECIFICATIONS WITH GASES THAT DO MEET SUCH SPECIFICATIONS, BUYER KNOWINGLY
AND FULLY ASSUMES THE R13KS OF TRANSPORTING AND USING COMPRESSED GASES. SELLER SHALL NOT BE LIABLE FOR ANY DIRECT(EXCEPT AS
EXPRESSLY PROVIDED *sRew). INDIRECT, SPECIAL. INCIDENTAL, CONSEQUENTIAL AND/OR PUNITIVE DAMAGES,ARISING on ALLEGED ro 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 on OMISSION omm RELATED To STRICT LIABILITY.u*OTHERWISE.
Iwoscf-PPm,)qz Unless^me.^/oesnmyoau:nvco^t'a*.Buyer^hx:make payment~.full within m days after the date of'a,v*/sinvoice. Continued open account credit
/°xv,,jecto*/'°,`assess rent of Buyer's onawrz/condition nnuability m pay.A'atennvme"t charge Of 1s%uo the unpaid, »os/due balance,will oe assessed monmlv
(mmx"ux.�«zunoo�{�uuu> o'/�omummvm/�*u/m'enno�amomma,w��xem��co�dsa�ueomwu,wh/u`eva,ix/,mo
suoJarqv�� L000 notice and mco'mofunoenyi,n documentation Buyer o^o'/pay t:uooao surcharge m the event ofoovumwmu/noryo,ema��oxmoma�smmemu
m(a)power^nmnr raw mate"^w,s,mm the production u/pmuucy and/or/b>fuel.
Title m all rental env wro ',*m/,pinnlnuaelle,'snam* avyerm,it riot uove mo ify,remove m otherwise disturb any identification or other ."momof
Seller's�r,mwnn^any rental equipment
T8`eo A,v taxes imposed»%'federal State,mnuo'governmental authority on the Sale,use or possession o/Goods,u,the sale o,performance of services bvavA/rgao
comp,.`v shall ue paid uva^ye. 'nnux./mr/o the nuuhaoeprice.
Itemized Chaa�es: (a)The total amount due from the avvo,mav'Jn"/uuo various.te°.,eu ma,o*s, mc/"moo: oua,oeo for the^""u000 o//,aza'uoux mate/.a/suoa for
compliance with laws and regulations mou,m/ro hazardous ma/e'/aa:charges for x�.nuo^n.delivery onvsh'pvmo�anu!c,charges'or energy m fuel.None m the charges
represent tax or fee pv.d I"Or imposed by v..x government-aomn"tu ,nu all oro.v o»xmea are ,*mn,y/ by the Seller r'o no/leronu riot specifically quantified the
,elo'wnmi�,uetw^er,the'ha�ossnum^arun'my�er�u����x�me�xamm.vx�c`can v^�u`�nu�m newu "m~orunm" omvo ^merm`ogc, (»)mosuch
��no,/,^o'maov �Ur ri a Ridor wlii w)osed w/"."`w*v" :u`;co/
x" U.S *�mm^,a�^uundy'u�r�a�o�and rmw�"um and auoom ,xo �o,mm":r�uu�/ a
y `^ec~''``'��r,,°""an°'mant~oo and s `vecm=/!�,ueo.mwmne/ No, 11 246�the Rehabilitation Act mmr,j and the Vietnam Era Veterans Readjustment
Ass:m""^=^�c,of`o'4,all a^~",a"ueu.
' A`o°, zerv.°,m*.°.+. �m`, , n ��naeaysmeoo
�m�a»�w�""x ' e"~ ~`�°e�u�m��v"va»naac*m �mu'»^w« m see xu="w=air9a^.pom Can m,veyou
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 7/24/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/24/2013 9910971999 $52.89
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
VOUCHER # 136045 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
9910971999 01-7362-06 $52.89
Voucher Total $52.89
Cost distribution ledger classification if
claim paid under vehicle highway fund