HomeMy WebLinkAbout225257 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 355856 Page 1 of 1
ONE CIVIC SQUARE AIRGAS MID AMERICA CHECK AMOUNT: $52.89
CARMEL, INDIANA 46032 Po BOX 532609
ATLANTA GA 30353-2609
CHECK NUMBER: 225257
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 9913442987 52 . 89 OTHER EXPENSES
CYLIN DER RENTAL INVOICE
•- s®- a-- ® s • II •o g�gj%. Airgas USA,LLC INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT
Marietta,9GA 30065-2249 09/30/2013 1813998 9913442987 10/30/2013 $52.89
0 0 ! 0 AMOUNT ENCLOSED
SOLD BY AIRGAS USA, LLC ❑ Check S0.189
5430 W MORRIS ST ❑Credit Card
INDIANAPOLIS IN 46241-3429
317-243-6606 Please visit www.airgas.com/onlinebilipay or
complete the information on the reverse side of this form.
1'11'1111'1'III"11111'11'111"1111111111111111111.111111'1111111
T460**AUTO 3-DIGIT 460 PL7 S296 1111'11'11"11'11"11111'I'111'11'li'illl"liill'1111'I"1111"II
BILL TO (CITY OF CARMEL SEWER
1 CIVIC SQ AIRGAS USA, LLC
CARMEL IN 46032-2584 PO BOX 532609
ATLANTA GA 30353-2609
132201
18139981991344298700000052896
- - ---------------- -- -TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693
INVOICE NO.
INVOICE:
_8 SQLQ TO VUMB ATE APuRCHASEZ R V TERMS
99134429871 1813998 1 1778561 1 09/30/2013 RENT NET 30
MfATERIAL r DESCRIPTION sUt3 lECT
SSG:SAt SKIP R>TURN AOJ SN1D SAL l I~ASSS tdBT DAYS RATS PRICE
aOCUMENT1t)A7 TO RENT
am
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 $0.59/1DAY $17.70 N
-- ----------------------------------------------
3 0 0 0 3 $36.14
Hazmat: 16.75
Imaortant.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the AMOUNT'DUE $ 52.8 9
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 e
provisions by written advice to us within(15)days after the date of this document.
SHIP To-1778561_
HUM�(��� CITY OF CARMEL SEWER — AIRGAS USA,LLC
�Jt�! www.airgas.com 130 1 ST AVE SW Acct No.8606074182
Airgas USA,LLC
CARMEL IN 46032-2009 PNC Bank,ABA No 031000053
PO Box 9249
Marietta,GA 30065-2249
REV 1.1.13 SEL-001000 Page 1 of 1
CREDIT CARD BOLLING
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#
frorn the reverse side.
� — —_-
Disclosure
Terms of Saie7eacx mof Goods services be gov erned by the terms and con&ions on this Disclosure,the Terms mSale mwed
to the Accojnt Application if one has been completed),and the terms of Sale found at hit .11WWW.al !S.CQM� UStOMOr SOrViCC.iterms.asp - -ly the"ferms of Sale").
---212 x(collective
Each Conlrpct to,,the sn!e of'Goods or seivices between Seller anc Buyer("Contract')shall include these Terms of Sale,iogrether with any other material de.scr'�Ilinq the
Good,or serv.ces being,sold,their price,delivery terms,and al,other ecial provisions. "Goods"refers to any items of tangible,personal property described in any Contract
so
m othei,,,vise provIded by Seller to Buyer-
This document shows,m^total number of cyknders charged m Buyer(ie,cylinders which,Seller has rented*
cased to Buver,and isrhich Buyer has not returned)according to Seller's records as of the nionth en6ng date shown,The number ofovxnu*m thus charged to buyer shall u*
u.n"memu correct for mxmnmmma/pu between Buyer and Seller,unless Buyer reports to Seller in'writing an Buyer claims wnmnaovaysamc[tie date»omo/
Buyer agrees to continue rQ pay rent on all cylinders charged to Buyer until Buyer has either(i)returned Such cylinders to Seller in good ,vorking order or(ii)pays Seller the
rev/uoement com,mei eo
remain mavmv xyofmrgesur/ts/mrd-paxy,eouors. Such q^/nues shall riot be u�muv
ouotOme/for,nmrpuseum»er than the storage of gas products purchased from mm000,the return and reclamation moe*aiogases(e.y.nanyerants). sammouame
oronu°r will ue°vbjeo�ma cylinder deposit uoasnmnm/sxmzovmrgasfromometoume. x/mas will refund the uepomu fee when lie ouu!iime,e/vmamummoeraot
cy:mcer uniess the cylinder's coridit�n is deemed to be unfit for rouse,as determined by Airgas.which determination shall be irrefutable s.xty dlays after one cvlinder was
��mao
y�ou
All nmovo�, mx*r tern s of^a/e. cylinders and other containers furnished by an xvgaa company vxan conform to the ueumpoon mereor m/mva by ma
nn—vf7C-oe,nt the umem sale and wm meet Seller's
purity specifications for mo products. ocuEn SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS mRIMPLIED
STANDARDS, GUARANTEES, on WARRANTIES. INCLUDING ANY WARRANTIES op MERCHANTABILITY, FITNESS FOR A PARTICULAR punpoason NON-
INFRINGEMENT AND ANY WARRANTIES THAT MAY as ALLEGED ro ARISE AS A RESULT op CUSTOM omUSAGE.
. SELLER SHALL ns LIABLE ONLY FOR THE REPAIR om REPLACEMENT or DEFECTIVE GAS CYLINDERS AND PRODUCTS, INCLUDING
THE eEIPLACEMsmT OF GASES THAT DO NOT MEET ITS PURITY SPECIFICATIONS WITH GASES THAT DO MEET SUCH SPECIFICATIONS. BUYER NNoWINGLY
AND FULLY ASSUMES THE RISKS OF TRANSPORTING AND USING COMPRESSED GASES. SELLER SHALL NOT BE LIABLE FOR ANY DIRECT(EXCEPT AS
EXPRESSLY PROVIDED*sme/w), 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 on OMISSION onm RELATED ro STRICT LIABILITY,onorHsR:v/as
Terms Of
JauouLnL Unless ome/w/,o specified maCovtract..Buyer shall make pavmon m full within ao days after the uetom Seller's invoice Cori unueu open acovomcredo'
/as/uiac/toSeller s assessment of Buyer's nnooc/a/condition and ability to day.A late payment charge m1,s%oon me"nvn/u, past c,u*�a/anoe. wmue .nonoh//
(rnlr";:noa-e two dollars(S2'00).01'the maximum lawful rate allowable in the stale where the Goods arc,delivered,whichever is less,
Upon nunne and receipt munuar/yIno documentation,Buyer shall pay tu Seller a surcharge m the event stony extraordinary v,c'nr,uenn/increases m the cost
of andlor rao;rnateriAIS used in theproduction of Products andlor(b)fuel,
TiU�bUEnuipugn1, T:tlp to,ail rental equipment shall remain in Seller's name. Buyer shall not cover,modify,remove ot oifienivise disturb ary idenfification oi mher indicia of
oo/mr'u ownership oounv rental equipment,
IoxamAmvtaxoo/mpcseuyxfeuera/.umte..u,ume,omemmenm/uvmomvoomesm/a,uwo,nnss*,m/*nmaooda.urmeea/eornom»nnmnvnofoewimmuvanAimax
ovmnun»o,^o be Paid,by Buyer in auumon Lo mePurchase n,/ce.
(o}The mw'amo"nl,uuofrom the Buyer mav include various itemized cxa.00s. /oclvumo:voa,oeo mrma xanmmo or xaza,doua ma�m/a/o arid for
corn;,,,:iancevvith laws and regulations concerning hazardous miaterials:charges for handling,delivery arid shipping;andforcharges for erpigy orfue!�Nono oFthe charges
,ep�xon/a lax urreeremmo'imposed uv any government authority, and ail (if the charges are rewmeo uvma seua,.The oaoe,:a;nol vpeuaca/")y:uenuoeu me
m/nnn:m/punweenmovxnmaoano the aomo/costs vp`oc/m=uwith the charges,which can vFry by product,service,timc,and place,umong other V,inqs. No such
000qeano�a/*ouvvrcvueum,meRme'vmue/mpos'euWuoav[Mutual cuooant.
� Contain wmasovmoan/es arc,u.m,government contrac.lors arid""umntrauuo and arc svbjeo�/u and aoxommmemuv/m°anwurmd°m//aws.
o^onvvvmome,y,anaao»nuomm`evanamov/ouvns.s�cmu,xvs`�ouveo�e,No. 1,2w6.mvn*oom//mun^z/�,or3 and m^memams�wyesoonem�unumen�
AumuuJnce Act of 1971 u/ asyr'neridau
A/m^«"B"y/"oss
Now xnmn business wimA/muym easier mm`ever with our^susmassweunito.huv:xwnw.u/rgum,com, Visit vsommo today w see how rwwmma,,ourn can y,a*you
VOUCHER # 136641 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
1
9913442987 01-7362-06 $52.89
I
Voucher Total $52.89
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 10/17/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/17/201: 9913442987 $52.89
1 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