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Home My WebLink About228425 1/28/2014 CITY OF CARMEL, INDIANA VENDOR: 366748 Page 1 of 1 ONE CIVIC SQUARE AIRGAS USA, LLC CHECK AMOUNT: $54.09 CARMEL, INDIANA 46032 PO BOX 532609 ATLANTA GA 30353-2609 CHECK NUMBER: 228425 CHECK DATE: 1/28/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 9915649675 54 . 09 OTHER EXPENSES g0 �$3 z331 CYLINDER RENTAL INVOICE •- •99- •-- o • e 1 •e . Airgas USA,LLC INVOICE DATE PAYER INVOICE NO. DUE DATE PAY THIS AMOUNT Airgas. PO Box 9249 12/31/2013 1813998 9915649675 01/30/2014 $ 54.09 Marietta,GA 30065-2249 0 , AMOUNT ENCLOSED SOLD BY AIRGAS USA, LLC Check �� 5430 W MORRIS ST INDIANAPOLIS IN 46241-3429 ❑Credit Card 317-243-6606 Please visit www.airgas.com/onlinebillpay or complete the information on the reverse side of this form. I"'I'lulul'I'"'III"r"'I'Inll"'In'Inir'I"II'llln'n' 133881 1 AT 0.381 T466 3DG460 PL7 S296 IIII11'1'"11'""111'1'''1"'11''1'1111"11111'Illl'I"1111"I' BILL TO {CITY OF CARMEL SEWER 1 CIVIC SO AIRGAS USA, LLC CARMEL IN 46032-2584 PO BOX 532609 ATLANTA GA 30353-2609 133881 18139981991564967500000054098 -------- - ------------- ---- - - -- - --- - -- ---- --- ...... -TO ENSURE PROPER CREDIT PLEASE RETURN THE UPPER PORTION WITH YOUR REMITTANCE.FOR QUESTIONS ON YOUR ACCOUNT PLEASE CALL: 800-727-0693 INVOICE NO. I>SOLD TO NUMBER` s' SHIP:TO :'i::° ::: :: INVOICE DATE 'RENTAL PURCHASE ORDER NOI < 99156496751 1813998 1 1778561 1 12/31/2013 RENT NET 30 MATERIAL(DESCRIPTION SUBJECT BEG BAL SHIP: RETURN ADJ END BAL LEASES_ _ NET DAYS RATE PRICE- 'DOCUMENT/.DATE TO RENT '. RRCYLISM-AC - Rent Cyl Ind Small Acetylene 2 0 0 0 2 1 1 31 $0.61/DAY $19.05 N RRCYLISM-OX - Rent Cyl Ind Small Oxygen 1 0 0 0 1 0 1 31 $0.59/DAY $18.29 N ------------------------------------------------------------------------------------------------------------ -------------------------------3-----0-- - 0 0 3 537.39 ------------------------------------------------------------------------------------------------------------ 0J. -73(,9 -0(0 ------------ 0J. -7369 .0(0 Hazmat: 16.75 Important.See the Notice Regarding Cylinder Rentals/Leases and Responsibility on the ,AmbUNT` <; $ 54.09 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 CITY OF CARMEL SEWER AIRGAS USA, LLC Airgas. 130 1 STAVE SW Acct No. k,ABA4 o 0 www.airgas.com PNC Bank,ABA No 031000053 Airgas USA,LLC CARMEL IN 46032-2009 PO Box 9249 Marietta,GA 30065-2249 REV 1.1.13SEL-001000 Page 1 of 1 CREDOT CARD MOLLUM6 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 piease provide your Airgas acct# ant', Invoice # froth tate re\,erse sine. Disclosure Terms of Sale: 17<-;ch sale of—,00ds of srr,kes by an Airgas 11 company i,.and shall lhy governed by the terms and conditions on this Disclosure,the. Terms of Sale affixed to the Account Application(if one has been completed),and the-terms of Sale found at http_1l.LvY1v)k,AiFgiAs.-con),Icustomer servicciterms.aspz(collectively the"Terms of Sale''). Each Contract for bip&ife of Goods or services between Seller and Buyet ("Contract"')shall includ,-.these Torm,ofSait.,together Oth any ether rraterir,'descnbrt,c.fle Goccis i-services bung sold,their price delivery toms,and all other special prov,sions. "Goods"refers to any items of tangib!e personal p-operty,described in any Contract or otherwise pi ovided by Sel;ei to Buyer, Notice R;!aardinj(' I �-_Iinder R,,nials/Leasus and Tris dominent shows the total number of cylinders chiii,yed to Buyer h,e.,cylinoets whi;.h Seiler bras renteti or L — ' , leased to Buyer.and which Buyer has not returned'according to Seller's records as of the month ending date shown, ,he number of cylin,k(s thus cr--rgLa to au;,-.r sliall oe considwi,id corrocl f,)T all co;l,acijl!;)IN,01,03 be;we,J)Buvc' .wr!Sellor,'finless Boy,;r reporli,to Seller in miring any-trors Bry-if:1aims`r'lh;!:60 fim,-,aflorll�e'i ite horpof Buyer a�,,,rees to continue to my rent on all cylinders-ha,gec to Buyer until Buyer has either(i)returned such cylinders to Se'ler:-,good viorking order or fii"pays Seiler tre replacement cost thereof. Refrigerant Cylindor Ret oins Dcposil Refillable refrigerant cylinders shay remain the oroperty of Airgas or its third-party vendors. Such cylinders shall ll,,I be U,(,(;ily Customer for pu,i)oses other trian the slurage of gas products purchasec.:-orn Airgas or the rerun,and ret.,lamation of Certain gn.sEi5 fe.g_ irrc�-rana,). Each retilk�,-)Ie cylit,;Irr be to a c,,I'ndor dr:pw,il.fee,as(--;Iabliihcd by Airgas from tirno to fine. Airgas will refund the deposit foe when the Ct,sicrrer rewriii,the refi,](,,,rint cylinder unless the cylincer's condition is ceemed to be Unfit for reuse,as determined by Airgas,which determination shall be irrefutable sixty days after the cylinder vias el All piocjcjs, otrier items of sale, cylinders and offiGr coniarners furnished by an Airgas company sharl conforrTl to the &.scriptioii thvi-co' pus'wJlvd Dy t�,o manufacturer at;rie time of;;,ale and will ineet Serler's purity specifications for all gas products,. SELLER SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS 09 IMPLIED STANDARDS, GUARANTEES, OR WARRANTIES, INCLUDING ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON- INFRINGEMENT OWINFRINGEMENT AND ANY WARRANTIES THAT MAYBE ALLEGED TO ARISE ASA RESULT OF CUS l'OM OR USAGE. Lim!rati--,, SELLER SHALL BE LIABLE ONLY FOR THE REPAIR OR REPLACEMENT OF DEFECTIVE GAS CYLINDERS AND PRODUCTS.IPCLIJDI,-IjG THE REPLACEMENT OF GASES THA. DO NOT MEET IT6 PURITY SPECIFICATIONS WITH GASES CHAT DO N;EET SUCH SPECIE CATIONS BUYER Ki,OWING:'r AND FULLY ASSUMES TI--- 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 PLRIFORMANCE OF ANY OBLIGATIONS ORANY PRODUCT,OTHER ITEMS OF SALE.OR EQUIPMENT SOLD OR LEASED BY SEL LER.WHETHER SUC14 DAMAGE RESULTS FROM ANY NEGLIGENT ACT OR OMISSION OR IS RELATED TO STR!rl-LIABILITY,OR OTFIl (WPkNome'a 0111,"ss r."herwise sp,ucificd in a llontract buyer slhell1 irfac pz;Ynl,-,nt.'I fl.; '!vill:in 30 c::ys,after,the 'iatc,o` nvo ,, Co-lf, r,c r t of!3(iyei's fina,.cia,coedit-nn anc abli-tv to pay,A'rite payn eni charge of ' 5n,,i,ie tie as-esr.ec month;y itTlinirnu-,two uu ars i$2.00.),of the maAmiurn lawful rate aliovvable n tric.state whore the Goods are deh,,-,rod vvt:ich,,,e: s (61, Sur barges! Upon notice and receipt of underlying documentation,Buyer shall pay to Seiler a surcharge in the event of any extraordinary or emergency increases in the cc+st of a,ipower ancior aw rnatr-t:ialsused if,"tie production ofProducts andior(D)fuel. Title to all renta,equipment shall remain in Seller's came. Buyer shall not cover,modify,remove or otherwise disturb any identification or otnirir iodici;l of Seller's ownership an any r,:,ital equ pirient. Taxes Any taxes imposed by federal,state,or other goveramental authoritv on the sale,use or possession of Goods,or the stile or perIormance o,,services t, a,,A,r—'; p,-jid by 6 iyet in,Odir:on to Nk:(i ter-d/f-I C!-arcus, (e)The iotal amou-11 ci!.e Iron, ;he Buyer inay mcludle Vaf+OLIS iLetilizei: charges, iri,.:Iudiny. (Jiiryes"i; tilhiovlria ofh<,/a ioos riAu, sus r,ri(. LU'T'�,11211GC -its 1,iws ard r-gui3tions u-,incernir,3 -.-izardou:--ni3terials .'Aiarges torhandlir,,.r,0eliverya-.c.1 shippin(iR 'ges for m-'rg'y,:1!-f---l.%1onl-,,of�it,ciar r est osf`nt t=ax y�,-fee:o�ii(4 to or rriho, ni ed by any govenieni authonk, and all of[tie charges are retained by the Sefor "tic Selloy has not soz)cfrcall, qtr;m,f,ed lie relatium-sh p betveei the ci,arges and the aclua;c03ts asscctated with the charges,which can vary by product,scr-,ice,tin place a,i,ong ji+No not aP, provic', "'for It.il R!10-Wili 1a1� 'Vilhol-11 Pik:Jai COMsenl- Go,,,crn;iie!1 C(,nlracts Ci-uiii,Air( ,3Ds C'Onlpari,-s c,rci U S goverriniow contractor.,:and sur-icotaractors and arc:si,ujoci to -idlhere .tt;c rcqui vrerils:;f der-al excci%l'-e oder and rulesa,)d tegu Mien%-,pe,,ifically Exe,��Jivp 0-ier No 11246,the Retha -,) bilitation AQt of 197S -id the Vietnam Era Veterars Re.adjL;S11n'r?F.t Assista-ice Act of 1974,all as amended Airgas oBusiness Nov;doing business with Airgas is easiei than ever with Our eBusineiis website,http://www.airgas.coni. Visit us online today!o see hove www.ati,gas.coni can Save y0- tinic, mj money 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 12/30/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/30/201; 9915649675 $54.09 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 VOUCHER # 137227 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 9915649675 01-7362-06 $54.09 Voucher Total $54.09 Cost distribution ledger classification if claim paid under vehicle highway fund D o b.