HomeMy WebLinkAbout234819 07/16/14 ♦y u!.�AgyF CITY OF CARMEL, INDIANA VENDOR: 00352895
® ONE CIVIC SQUARE CULLIGAN WATER CONDITIONING CHECK AMOUNT: $***'*1,168.95'
x =Q; CARMEL, INDIANA 46032 1104 S STATE ST CHECK NUMBER: 234819
9,y�(tpry'Gp` WASECA MN 56093-3145 CHECK DATE: 07/16/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350100 6314 1,168.95 BUILDING REPAIRS & MA
PREVIOUS BALANCE: I $0.00
DATE QUANTITY DESCRIPTION REF ( AMOUNT BALANCE
06/18/2014 1.00 RO COMMERCIAL SALE 839.00 839.00
06/18/2014 1.00 EVERPURE INSURICE COMM SALE 329.95 1168.95
ACCOUNTS ARE SUBJECT TO A LATE PAYMENT FINANCE CHARGE
FINANCE CHARGE SCHEDULE PLEASE PAY NEW
OVER PERIODIC RATE ANNUAL RATE BALANCE BEFORE
s = 1.75% -1.00 a JIIL 25
Balance Due $1168 . 95
TO 1_I y I_I_1_I II q MIN I II_I
CHARGE
it-,jlv1-i ll f, cr,,eL =
Next Deliveries:.
_ -
CI.Illig n r Bcon_ ounr_y
FG ['o_ 7'17
L=barlon, I11 -1 111.5'
(765) 4E2-2570 (317) 73-x772
SERVICE ADDRESS:
`::F:IdEL FIFE DEET T.,TIUII U41
JIM
IRCLE ROQ
bUi-.F:E STATEMENT DATE ACCOUNT NUMBER NAME
- �". LE
CrF:1dEL I11 -15113_ ?n/301_1.!1-1 11373` 'AF:IIEL FIRE DEFT 3TRTII?II Y41
113738
O-A� 0 ��-Znvoke
A 6314JUNE 18,201L
Culligan Water Conditioning of Boone County
PO Box 797
1328 W Main St
Lebanon, IN 46052
765-482-2570 317-873-8772
booneculiigan@mymetronet.net
To: Ship to (if different address):
CARMEL-FIRE DEPARTMENT.STATION #41-
JIM SPELBRING
2 CIVIC SQUARE
CARMEL IN 46032
Quantity Description Unit price Amount
1 AQUA CLEER 50GPD W/10GAL TANK 839.00
1 EVERPURE INSURICE 2000 329.95
1 INSTALLATION INCLUDED
Subtotal 1168.95
Sales Tax EXEMPT
Total !due $1168.95
Please detach portion below (cut at line) and send with your remittance.
❑ CHECK HERE IF CHANGE OF ADDRESS__
Account Number: 113738 If you have any questions regarding this
Amount Due: $1168.95 bill, please contact:
Amount Enclosed: 765-482-2570
Mail Payment to: 317-873-8772
Culligan Water of Boone County booneculligan@mymetronet.net
PO Box 797
Lebanon, IN 46052
Attn: Accounts Receivable
Thank You For Your Business!
Or pay online at: www.culligancentralindiana.com
&d4&4A_a,
CUSTOMER ORDER DATE
ORDER ACCOUNT#
MARKETING SOURCE:
® r ❑SAME AS SERVICE ADDRESS
NAME _ NAME
ADDRESS J ADDRESS
CITY STATE ZIP CITY_ STATE ZIP COUNTY_
COUNTY CONTACT NAME: • s
CROSS STREETS/LOCATION____ ,___ BLUING TERMS ❑131-MONTHLY ❑QUARTERLY ❑SEMI-ANNUALLY
HOME-# WORK#-_—_ ❑ANNUALLY L_I AUTOMATIC MONTHLY BILLING
EMAIL EMPLOYER PAYMENT METHOD ❑CASH ®DEBIT 0 CREDIT CARD ❑FINANCING
DRIVERS LCENSE# BANK—_—___ _ BRANCH
BANK ACCOUNT# —_- ❑SAVINGS ❑CHECKING
CREDIT CAPD# EXPIRATION DATE
❑ PRNATf HOME ❑ APARTMENT ❑ COPAM1fRCfAI OCCUPANTS___- _ --
VESA® E3= ❑
❑: MUNICIPAL SUPPLY ® PRIVATE WELL PSI RANGE __ to
INMAi SIGN UP FEE $ �} INSPECTION FEE b _❑ PRICE
FLOW RATE—gpm ESTIMATE PJATER USAGE gal.per F TOTAL OF AL THA4.'?LY TRAM YSFER,EE $_—___
Al ALNITY___TDS N7RATES TURBIDITY
ANNUAL PAYMENT 5 •- ❑ hNT(:.LS -
IRON _--`--SULPHUR----------- --.-_-PH HARDNESS 9P9 TAX 's EXEMPTION
TOTAL.BALANCE OWING
limi;a'ions:'daro'iuns i,wvr s+•o!cr supaty 11cm the chive CUSTOMER KNOWS THAT
aralysis may olfed the pe;farrnat,e c€this ecuipnent. SPECIAL.NSTRU•`CTiONS _A
Adiv mens and/orodd:t:onal equ!"',erti r-1 be re�ci ed. HOSEBIS i5 Sot-T, In++to'.e---___-__- I
T'ise,,l bn Provided at aur pey6l:ng ra'es. _
QTY. MODEL I DESCRtPT1ONDE5CR7( N r SER?ALR { PURCHASE DAs- ( PR!CE
P?JCE r"c�1T.4L?£�E k
INSTALLATION CHARGE
a
? TOTAL INITIAL RENTAL CHARGE
SALT DELP'/ERY ❑YES ❑NO SALT Ibs.@ S rPer
D.bJE
I ❑A1v. ❑P 1
PURCHASE OTHER
1
CALL ❑LAY Or ®DAti'BEFORE PHIONE
I
FPURCHASE OTHER ( ? fiE-`rEST SCHEDULE DATE
RENTAL CTriEP, i
f
ADDITIONAL COiMMENTS:
RENTAL OTHER
DELIVERY FEE i y
BOTTLE DEPOSIT/CREDIT f
i
{
SECUR;TY DEPOSIT
r OTI;ER --� You,the buyer, may cancel this transaction at any time
prior to midnight of the third business day after the
TAY - date of this transaction. See the attached notice of
TOTAL t ..cancellation form for an explanation of this right.
L LESS RECEIVED WITH ORDER ❑CASH E3CHECK ❑CREDfT CARD ' Customer's signature __—
s
BALANCE DUE Print came —_---Dote.,
Representative Rep Code_
This order subieci to terms and conditions stated
an reverse side.Culligan dealerships are Deoiersnip approval
independently operated.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Culligan
IN SUM OF $
PO Box 797
Lebanon, IN ;6052 --- — -- - ------
$1,168.95
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 6314 43-501.00 $1,168.95 1 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
JUL 1 4 2014
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
i
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 service rendered, by
wi on-, r>ies per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6314 $1,168.95
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
, 20
Clerk-Treasurer