250119 1 0/07/1 5 Biu' '�. CITY OF CARMEL, INDIANA VENDOR: 354047
1 CHECK AMOUNT: $********71.29*
.�, '�,• ONE CIVIC SQUARE AQUA SYSTEMS
s. _� CARMEL, INDIANA 46032 7785 EAST US HIGHWAY 36 CHECK NUMBER: 250119
+M��itiri G�``0 AVON IN 46123 CHECK DATE: 10/07/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 2860010 71.29 OTHER EXPENSES
Aq,,LUA INVOICE
The Home Water ExpertsTM Order No. SI-2860010 Written By TBUCKLEY Order Date 09111!15
7785 East US Highway 36 Account# 150286 E„r,.-+R','N' +11Se”!5
Avon, IN 46123 �� Technician ciwvvniwruv Senr. Date�iie. �, i �
www.ilovemywater.co'm Bill to Account# 132505
Route Na Sequence 0
Name City of Carmel HHW Dept. '
Last Del. SAS 05128115 10
Address 901 N Rangeline Rd.
City Carmel IN 45032
Install Date Customer Installed
Phone#
317571-264.5
Hardness gpg Iron ppm ph
Ordered By -"
TDS ppm Watertype
Requested Time
�, •___ No. of People
k
Comments:NOT OPEN ON MONDAYS-T UESTHRU SAT-IF NOT THERE CAN
LEAVE AT CITY OF CMMEL-SEWER DEPT-SAME ADDRESS,
I
Exp-Qty- Act.Qty No- Description Tax Ali Price Tota!
12 2 SAS 5 Gallon Aqua Systems Bottle 0' 5.50
12 DSAS Deposit 5 gallon Aqua Systems 0 6.00
0 2 R5AS RTN 5 gal Aqua Systems bottle 00AC7 Z..
- -'(7
i
- -
------- _..__ _. ..... . .._._-... _ - ... - - .__ . .
I� ....`._._ T._-_.. _._- ._.. _ _.-. ___.._ _....-....
Scheduled Deliveries: 09/15/15
- Customer isnon-tar. r
RENTAL WARRANTY
�j CHARGE RETURN
tf � Please-pay_from thisbilL No
HOURS RATE •
Next Delivery Date 09J15J15 other billing will be mailed. Upon •
- - --- - - - receipt of merchandise or
services, customer agrees to
pay in full by,due date. If
Service/Delivery Tech. payment is not received, you are •
Customer Name-Please Print
subject to collection fees, court'
costs and attorney fees. 5>29
Customer Signature - - -
I hereby acknowledge satisfactory dompletion of above described Wbilt
t......' ..
30 Day Labor Warranty Due Date 10,+25/15 • a
VOUCHER # 156390 WARRANT # ALLOWED
354047 IN SUM OF $
AQUA SYSTEMS
7785 EAST US HIGHWAY 36
AVON, IN 46123
I
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
I
PO# INV# ACCT# AMOUNT Audit Trail Code
2860010 01-720H-08 $71.29
i
Voucher Total $71.29
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
354047
AQUA SYSTEMS Purchase Order No.
7785 EAST US HIGHWAY 36 Terms
AVON, IN 46123 Due Date 10/1/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/1/2015 2860010 $71.29
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