Brenntag Mid-South, Inc./Streets 'Brenntag Mid-South,Inc.•
A Strekt Department-2012 •
Appropriation#0043-504.00 ; P.O.#26280,27380
Contract Not To Exceed$38,040.00 •
Rot,
,
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ( n A
\\
THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is
hereby entered into by and between the City of Carmel, Indiana, acting by and through its Board
of Public Works and Safety ("City"), and Brenntag Mid-South, Inc., an entity duly authorized to
do business in the State of Indiana ("Vendor").
TERMS TERMS AND CONDITIONS
1. ACKNOWLEDGMENT, ACCEPTANCE:
Vendor acknowledges that it has read and understands this Agreement, and agrees that its execution of
same constitutes its acceptance of all of the Agreement's terms and conditions.
2. PERFORMANCE:
City agrees to purchase the goods and/or services (the "Goods and Services") from Vendor using City
budget appropriation number 0043-504-00 funds. Vendor agrees to provide the Goods and Services and to
otherwise perform the requirements of this Agreement by applying at all times the highest technical and
industry standards.
3. PRICE AND PAYMENT TERMS:
3.1 Vendor estimates that the total price for the Goods and Services to be provided to City hereunder
shall be no more than Thirty Eight Thousand Forty Dollars ($38,040.00) (the "Estimate"). Vendor
shall submit an invoice to City no more than once every thirty (30) days detailing the Goods and
Services provided to City within such time period. City shall pay Vendor for such Goods and
Services within sixty (60) days after the date of City's receipt of Vendor's invoice detailing same, so
long as and to the extent such Goods and Services are not disputed, are in conformance with the
specifications set forth in Exhibit A, are submitted on an invoice that contains the information
contained on attached Exhibit B, and Vendor has otherwise performed and satisfied all the terms
and conditions of this Agreement.
3.2 Vendor agrees not to provide any Goods and Services to City that would cause the total cost of the
Goods and Services provided by Vendor to City hereunder to exceed the Estimate, unless City has
previously agreed, in writing, to pay an amount in excess thereof.
4. WARRANTY:
Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to
those certain specifications, descriptions and/or quotations regarding same as were provided to
Vendor by City and/or by Vendor to and accepted by City, all of which documents are incorporated
herein by reference, and that the Goods and Services will be delivered in a timely, good and
workmanlike manner and free from defect. Vendor acknowledges that it knows of City's intended use
and expressly warrants that the Goods and Services provided to City pursuant to this Agreement
have been selected by Vendor based upon City's stated use and are fit and sufficient for their
particular purpose.
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• •B,re,*mtag Mid-South, Inc.
Street Department-2012
Appropriation#0043-504.00 ; P.O.#26280, 27380
Contract Not To Exceed$38,040.00
5. TIME AND PERFORMANCE:
This Agreement shall become effective as of the last date on which a party hereto executes same ("Effective
Date"), and both parties shall thereafter perform their obligations hereunder in a timely manner. Time is of the
essence of this Agreement.
6. DISCLOSURE AND WARNINGS:
If requested by City, Vendor shall promptly furnish to City, in such form and detail as City may direct, a list of
all chemicals, materials, substances and items used in or during the provision of the Goods and Services
provided hereunder, including the quantity, quality and concentration thereof and any other information
relating thereto. At the time of the delivery of the Goods and Services provided hereunder, Vendor agrees to
furnish to City sufficient written warning and notice (including appropriate labels on containers and packing)
of any hazardous material utilized in or that is a part of the Goods and Services.
7. LIENS:
Vendor shall not cause or permit the filing of any lien on any of City's property. In the event any such lien is
filed and Vendor fails to remove such lien within ten (10) days after the filing thereof, by payment or bonding,
City shall have the right to pay such lien or obtain such bond, all at Vendor's sole cost and expense.
8. DEFAULT:
In the event Vendor: (a) repudiates, breaches or defaults under any of the terms or conditions of this
Agreement, including Vendor's warranties; (b) fails to provide the Goods and Services as specified herein;
(c)fails to make progress so as to endanger timely and proper provision of the Goods and Services and does
not correct such failure or breach within five (5) business days (or such shorter period of time as is
commercially reasonable under the circumstances) after receipt of notice from City specifying such failure or
breach; or (d) becomes insolvent, is placed into receivership, makes a general assignment for the benefit of
creditors or dissolves, each such event constituting an event of default hereunder, City shall have the right to
(1) terminate all or any parts of this Agreement, without liability to Vendor; and (2) exercise all other rights
and remedies available to City at law and/or in equity.
9. INSURANCE AND INDEMNIFICATION:
Vendor shall procure and maintain in full force and effect during the term of this Agreement, with an insurer
licensed to do business in the State of Indiana, such insurance as is necessary for the protection of City and
Vendor from all claims for damages under any workers' compensation, occupational disease and/or
unemployment compensation act; for bodily injuries including, but not limited to, personal injury, sickness,
disease or death of or to any of Vendor's agents, officers, employees, contractors and subcontractors; and,
for any injury to or destruction of property, including, but not limited to, any loss of use resulting therefrom.
The coverage amounts shall be no less than those amounts set forth in attached Exhibit C. Vendor shall
cause its insurers to name City as an additional insured on all such insurance policies, shall promptly provide
City, upon request, with copies of all such policies, and shall provide that such insurance policies shall not be
canceled without thirty (30) days prior notice to City. Vendor shall indemnify and hold harmless City from and
against any and all liabilities, claims, demands or expenses (including, but not limited to, reasonable attorney
fees) for injury, death and/or damages to any person or property arising from or in connection with Vendor's
provision of Goods and Services pursuant to or under this Agreement or Vendor's use of City property.
-rappsl\User Data-Admin\LA\Nsharcd\Prof Svcs&Goods Svcs\Street\2012\BRENNTAG-Goods&Scry ices.dot:5/' 2012 1:a9 PSI]
Brenntag Mid-South,Inc.
Street Department-2012
Appropriation#0043-504.00 ; P.O.#26280,27380
Contract Not To Exceed$38,040.00
Vendor further agrees to indemnify, defend and hold harmless City and its officers, officials, agents and
employees from all claims and suits of whatever type, including, but not limited to, all court costs, attorney
fees, and other expenses, caused by any act or omission of Vendor and/or of any of Vendor's agents,
officers, employees, contractors or subcontractors in the performance of this Agreement. These
indemnification obligations shall survive the termination of this Agreement.
10. GOVERNMENT COMPLIANCE:
Vendor agrees to comply with all federal, state and local laws, executive orders, rules, regulations and codes
which may be applicable to Vendor's performance of its obligations under this Agreement, and all relevant
provisions thereof are incorporated herein by this reference. Vendor agrees to indemnify and hold harmless
City from any loss, damage and/or liability resulting from any such violation of such laws, orders, rules,
regulations and codes. This indemnification obligation shall survive the termination of this Agreement.
11. NONDISCRIMINATION:
Vendor represents and warrants that it and all of its officers, employees, agents, contractors and
subcontractors shall comply with all laws of the United States, the State of Indiana and City prohibiting
discrimination against any employee, applicant for employment or other person in the provision of any Goods
and Services provided by this Agreement with respect to their hire, tenure, terms, conditions and privileges of
employment and any other matter related to their employment or subcontracting, because of race, religion,
color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or Vietnam era veteran
status.
12. E-VERIFY
Pursuant to I.C. § 22-5-1.7 et seq., Company shall enroll in and verify the work eligibility status of all of its
newly-hired employees using the E-Verify program, if it has not already done so as of the date of this
Agreement. Company is further required to execute the attached Affidavit, herein referred to as Exhibit D,
which is an Affidavit affirming that: (i) Company is enrolled and is participating in the E-verify program, and
(ii) Company does not knowingly employ any unauthorized aliens. This Addendum incorporates by reference,
and in its entirety, attached Exhibit D. In support of the Affidavit, Company shall provide the City with
documentation that it has enrolled and is participating in the E-Verify program. This Agreement shall not take
effect until said Affidavit is signed by Company and delivered to the City's authorized representative.
Should Company subcontract for the performance of any work under this Addendum, the Company
shall require any subcontractor(s) to certify by affidavit that: (i) the subcontractor does not knowingly employ
or contract with any unauthorized aliens, and (ii) the subcontractor has enrolled and is participating in the E-
verify program. Company shall maintain a copy of such certification for the duration of the term of any
subcontract. Company shall also deliver a copy of the certification to the City within seven (7) days of the
effective date of the subcontract.
If Company, or any subcontractor of Company, knowingly employs or contracts with any
unauthorized aliens, or retains an employee or contract with a person that the Company or subcontractor
subsequently learns is an unauthorized alien, Company shall terminate the employment of or contract with
the unauthorized alien within thirty (30) days ("Cure Period"). Should the Company or any subcontractor of
Company fail to cure within the Cure Period, the City has the right to terminate this Agreement without
consequence.
The E-Verify requirements of this Agreement will not apply, should the E-Verify program cease to exist.
[\Vssvrappsl\User Data-AdminU.A\1^sharcd\Prof Svcs&Goods Svcs\Street\2012\BRENNTAG-Goods&Services doc:5/2,j2012 1:49 PM]
' B,renntag,Mid-South, Inc.
Street Department-2012
Appropriation#0043-504.00 ; P.O.#26280,27380
Contract Not To Exceed$38,040.00
13. NO IMPLIED WAIVER:
The failure of either party to require performance by the other of any provision of this Agreement shall not
affect the right of such party to require such performance at any time thereafter, nor shall the waiver by any
party of a breach of any provision of this Agreement constitute a waiver of any succeeding breach of the
same or any other provision hereof.
14. NON-ASSIGNMENT:
Vendor shall not assign or pledge this Agreement, whether as collateral for a loan or otherwise, and shall not
delegate its obligations under this Agreement without City's prior written consent.
15. RELATIONSHIP OF PARTIES:
The relationship of the parties hereto shall be as provided for in this Agreement, and neither Vendor nor any
of its officers, employees, contractors, subcontractors and agents are employees of City. The contract price
set forth herein shall be the full and maximum compensation and monies required of City to be paid to
Vendor under or pursuant to this Agreement.
16. GOVERNING LAW; LAWSUITS:
This Agreement is to be construed in accordance with and governed by the laws of the State of Indiana,
except for its conflict of laws provisions. The parties agree that, in the event a lawsuit is filed hereunder, they
waive their right to a jury trial, agree to file any such lawsuit in an appropriate court in Hamilton County,
Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same.
17. SEVERABILITY:
If any term of this Agreement is invalid or unenforceable under any statute, regulation, ordinance, executive
order or other rule of law, such term shall be deemed reformed or deleted, but only to the extent necessary to
comply with same, and the remaining provisions of this Agreement shall remain in full force and effect.
18. NOTICE:
Any notice provided for in this Agreement will be sufficient if it is in writing and is delivered by postage
prepaid U.S. certified mail, return receipt requested, to the party to be notified at the address specified
herein:
If to City: City of Carmel AND Douglas C. Haney, City Attorney
One Civic Square Department of Law
Carmel, Indiana 46032 One Civic Square
ATTENTION: Carmel, Indiana 46032
If to Vendor: Brenntag Mid-South Inc.
3796 Reliable Parkway
Chicago, IL 60686-0037
Telephone:
E-Mail:
ATTENTION: Justin Latta
Notwithstanding the above, notice of termination under paragraph 19 hereinbelow shall be effective if given
orally, as long as written notice is then provided as set forth hereinabove within five (5) business days from
the date of such oral notice.
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•
Brenntag,Mid-South, Inc.
Street Department-2012
Appropriation#0043-504.00 ; P.O.#26280,27380
Contract Not To Exceed$38,040.00
19. TERMINATION:
19.1 Notwithstanding anything to the contrary contained in this Agreement, City may, upon notice to
Vendor, immediately terminate this Agreement for cause, in the event of a default hereunder by
Vendor and/or if sufficient funds are not appropriated or encumbered to pay for the Goods and
Services to be provided hereunder. In the event of such termination, Vendor shall be entitled to
receive only payment for the undisputed invoice amount representing conforming Goods and
Services delivered as of the date of termination, except that such payment amount shall not exceed
the Estimate amount in effect at the time of termination, unless the parties have previously agreed in
writing to a greater amount.
19.2 City may terminate this Agreement at any time upon thirty (30) days prior notice to Vendor. In the
event of such termination, Vendor shall be entitled to receive only payment for the undisputed
invoice amount of conforming Goods and Services delivered as of the date of termination, except
that such payment amount shall not exceed the Estimate amount in effect at the time of termination,
unless the parties have previously agreed in writing to a greater amount.
20. REPRESENTATIONS AND WARRANTIES
The parties represent and warrant that they are authorized to enter into this Agreement and that the persons
executing this Agreement have the authority to bind the party which they represent.
21. ADDITIONAL GOODS AND SERVICES
Vendor understands and agrees that City may, from time to time, request Vendor to provide additional goods
and services to City. When City desires additional goods and services from Vendor, the City shall notify
Vendor of such additional goods and services desired, as well as the time frame in which same are to be
provided. Only after City has approved Vendor's time and cost estimate for the provision of such additional
goods and services, has encumbered sufficient monies to pay for same, and has authorized Vendor, in
writing, to provide such additional goods and services, shall such goods and services be provided by Vendor
to City. A copy of the City's authorization documents for the purchase of additional goods and services shall
be numbered and attached hereto in the order in which they are approved by City.
22. TERM
Unless otherwise terminated in accordance with the termination provisions set forth in Paragraph 19
hereinabove, this Agreement shall be in effect from the Effective Date through December 31, 2012 and shall,
on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless
otherwise agreed by the parties hereto.
23. HEADINGS
All heading and sections of this Agreement are inserted for convenience only and do not form a part of this
Agreement nor limit, expand or otherwise alter the meaning of any provision hereof.
24. BINDING EFFECT
The parties, and their respective officers, officials, agents, partners, successors, assigns and legal
representatives, are bound to the other with respect to all of the covenants, terms, warranties and obligations
set forth in Agreement.
[\Vssrappsl Wscr Data-Admio\LA\V'I arcd\Pro1Svcs&Goods Ss cs\Svcct\2012\BRENNTAG-Goods&Sorvicos.doc:5'2�'2012 I:a9 PM]
' B,renntag,Mid-South, Inc.
Street Department-2012
Appropriation#0043-504.00 ; P.O.#26280,27380
Contract Not To Exceed$38,040.00
25. NO THIRD PARTY BENEFICIARIES
This Agreement gives no rights or benefits to anyone other than City and Vendor.
26. ADVICE OF COUNSEL:
The parties warrant that they have read this Agreement and understand it, have had the opportunity to obtain
legal advice and assistance of counsel throughout the negotiation of this Agreement, and enter into same
freely, voluntarily, and without any duress, undue influence or coercion.
27. ENTIRE AGREEMENT:
This Agreement, together with any exhibits attached hereto or referenced herein, constitutes the entire
agreement between Vendor and City with respect to the subject matter hereof, and supersedes all prior oral
or written representations and agreements regarding same. Notwithstanding any other term or condition set
forth herein, but subject to paragraph 16 hereof, to the extent any term or condition contained in any exhibit
attached to this Agreement or in any document referenced herein conflicts with any term or condition
contained in this Agreement, the term or condition contained in this Agreement shall govern and prevail.
This Agreement may only be modified by written amendment executed by both parties hereto, or their
successors in interest.
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA BRENNTAG MID-SOUTH, INC.
by and through its Board of Public
Works and Safety
By: By:
CDT Prviso
James Brainard, Presiding Officer Author' d Signature
Date. l ;-Pusnk Lq
74111
Printed Name
ary n Burk Member
Dat ���—l� Sv/PS -
Title
Lori S. atso m er FID/TIN: Li 5 5
Date: 7/5/
Last Four of SSN if Sole Proprietor:
ATTEST:
Date: , a 7 / 2
/ i I
rAiana Cordray, IAM Clerk-Treasurer
Date: �-/,2.,.
[\\Issvrapps l\User Data-Admin\LA\\'\shared\Prof S\'cs&Goods Svcs\Street\2012\BRENNTAG-Goods&Sery ices-doc:5,262012 I.49 PM]
RENNTA 'r,
City of Carmel Street Department
Specifications for City Reflecting Pond
2011
Chemical need will be determined by season, temperature and maintenance schedules.
Approximate On-Demand Usage Needs March through November:
Sodium Hypochlorite 12.5% 200 gallons per week
Approximate On-Demand Usage March through November:
Hydrochloric Acid 20 Deg TG 400 gallons per month
Yearly usage up to: 7000 gallons Sodium Hypochlorite 12.5%
Yearly usage up to: 4500 gallons Hydrochloric Acid Deg TG
Specifics:
• Chemicals need to be delivered and applied directly to the reflecting pool located at Third
Ave. and 126th St. in Carmel.
• Deliveries are to be scheduled for Mondays and/or Tuesdays, 8:00 a.m. til 4:30 p.m. No
deliveries are to be scheduled on weekends or the following Government Holidays;
Memorial Day, Fourth of July, Labor Day, Thanksgiving Day.
• City employee is to be present during all deliveries and applications which will require
prior notice of delivery time.
Discontinuance of Work:
Any practice that is hazardous, as determined by the Owner (City of Carmel) in its sole
discretion, shall be immediately discontinued by the Contractor upon receipt of either written or
oral notice to discontinue such practice from Owner.
Brenntag Mid-South,Inc.
1405 Highway 136 West(42420)
PO Box 20 Exhibit
Henderson,KY 42419-0020
•
City of Carmel Street Department
Specifications for City Reflecting Pool
2012
Observance of Laws, Ordinances and Regulations:
The Contractor, at all times during the term of the Contract, shall observe and abide by all
Federal, State and Local laws which in any way affect the Project or Project work, and shall
comply with all decrees and orders of all courts of competent jurisdiction.
MSDS sheet will be provided and kept at the Cannel Street Department building just
west of the Carmel Fire Department Station #1.
A sample Goods & Services contract is included for your review. One will have to be
signed by the successful quoter prior to work.
The prices below are firm until 9/30/2012
Price for 7000 Gallons of Sodium Hypochlorite (Delivered)... $2.83/gallon
$19,810.00
Price for 4500 Gallons of Hydrochloric Acid Deg TG (Delivered)$3.74p/gallon
$16,830.00
Delivery surcharge $1,400
Total Price $38,040 plus delivery
surcharge
No minimum purchase required
All billing will be sent to:
Carmel Street Department
3400 W. 131st St.
Westfield, IN 46074
Brenntag Mid-South,Inc.
1405 Highway 136 West(42420)
PO Box 20 A
Henderson,KY 42419-0020
i4
EXHIBIT B
Invoice
Date:
Name of Company:
Address &Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
GRAND TOTAL
Signature
Printed Name
EXHIBIT C
INSURANCE COVERAGES
Worker's Compensation & Disability Statutory Limits
Employer's Liability:
Bodily Injury by Accident/Disease: $100,000 each employee
Bodily Injury by Accident/Disease: $250,000 each accident
Bodily Injury by Accident/Disease: $500,000 policy limit
Property damage, contractual liability,
products-completed operations:
General Aggregate Limit (other than
Products/Completed Operations): $500,000
Products/Completed Operations: $500,000
Personal & Advertising Injury
Policy Limit: $500,000
Each Occurrence Limit: $250,000
Fire Damage (any one fire): $250,000
Medical Expense Limit (any one person): $ 50,000
Comprehensive Auto Liability (owned, hired and non-owned)
Bodily Single Limit: $500,000 each accident
Injury and property damage: $500,000 each accident
Policy Limit: $500,000
Umbrella Excess Liability
Each occurrence and aggregate: $500,000
Maximum deductible: $ 10,000
08-17-12; 10:01AM; ; 317-571-2265 # 2/ 2
EXHIBIT D
AFFIDAVIT
Christopher L. Kirby ,being first duly sworn, deposes and says that
he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this
matter, could testify as follows:
1. I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. I am now and at all times relevant herein have been employed by
Brenntag Mid-South, Inc. (the "Employer")
in the position of Sales Manager
•
3. I am familiar with the employment policies,practices, and procedures of the Employer and
have the authority to act on behalf of the Employer.
4, The Employer is enrolled and participates in the federal E-Verify program. Documentation
of this enrollment and participation is attached and incorporated herein.
5. The Employer does not knowingly employ any unauthorized aliens.
6. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
7. FURTHER AFFIANT SAYETH NOT.
EXECUTED on the 17th day of August , 20 12.
Printed: Christopher L. Kirby
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and representati ns are true and correct.
Printed: Christopher L. Kirby
Er
.: A :T:T
Today's Date: g / a 3 / 1 2-
CITY COUNCIL (Original and 8 Copies)
a E-Mail all ordinances and Resolutions (Include any Exhibits) to Lois Fine
X BOARD OF PUBLIC WORKS (Original and 5 Copies)
CHECK ONE:
Add-On
Next Meeting: q / / i Z
Future Meeting: / /
SPONSOR: (Person to be listed on Agenda)
Gv'ic\ fCmaq
DESCRIPTION OF ITEM:
rP M-1-6,S d- Jc�v k'rt -�nc_
ANY SPECIAL INFORMATION: (Special Equipment Needed, Verbal Presentation,
Etc.)
(....
" 0 INDIANA RETAIL TAX EXEMPT PAGE
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FEDERAL EXCISE TAX EXEMPT
' 35-60000972
ONE CIVIC SQUARE THIS NUMBER EAR ON INVOICES,f
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIF
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENC
URCHASE ORDER DATE DATE REQUIRED REQUISITION N• VENDOR NO. DESCRIPTION
4120120,1:
VENDOR Srenntag Wild Inc SHIP Street Department
TO 3400 W. 131 st.:
3796 Reliable Parkway•� Carmel,IN 4
CONFIRMATION .BLANKE p 9L.. ` . PAYMENT TERMS (3111134. FREIGHT
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QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Avert .00:
1 Each Reflecting plot chemicals $30,135.00
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PLEASE INVOICE IN DUPLICATE
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PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY— AT THE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID. THIS APPROPRIAT NT TO PAY FO HE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. / S
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY y�^ !/j�
SHIPPING LABELS. ,�% / V I/V'°'_
•THISS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
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DOCUMENT CONTROL NO. 8 0 VENDOR COPY
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®� INDIAL XEMPT PAGE
1 �� �' �`; CERTIFICATENA NO.RETAI 003TAX120E155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,I
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIF
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENC
JRCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO.
DESCRIPTION
VENFT2012 SHIP
TO
Erenntag Mid-South Inc Street Department
:ONFIRMATION BLANKET CONTRACT 3400 W. 131st Street
PAYMENT TERMS I FREIGHT
c'i:1u ea IraD e r ncway I Carmel, IN 46074
Chlcmci , II 7 (3171733-2001
QUANTITY I UNIT OF MEASURE DESCRIPTION
Justin Latta 1 UNIT PRICE I EXTENSION
Account 0043-604.00
1 Each Reflecting pool chemicals $27,503.54 $27,503.54
,-, f< Sub Total: $27,503.54
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PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER H E PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY C Y T THERE IS AN UNOBLIGATED BALANCE IN
C.,.e,
I+ekDStreet Department THIS APPR FFICIENT TO P, fOR THE ABOV$2 .5,4
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY Asi
SHIPPING LABELS. 9�/5��� �/�•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE / ^^'�'—"— l
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
') CLERK-TREASURER
)OCUMENT CONTROL NO26, 80 vFNnno rnov