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�,, t� CITY OF CARMEL, INDIANA VENDOR: 055000
;, ONE CIVIC SQUARE CERTIFIED LABORATORIES CHECK AMOUNT: $*******166.85'
9 ,,. CARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK NUMBER: 303977
M��TpNI�� CHICAGO IL 60673-1232 CHECK DATE: 10/10/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350400 2460783 166.85 GROUNDS MAINTENANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
CERTIFIED LABORATORIES ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
23261 NETWORK PLACE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
CHICAGO, IL 60673-1232 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$166.85 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Course Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
2460783 43-504.00 $166.85 1 hereby certify that the attached invoice(s),or 9/21/16 2460783 Repair Parts $166.85
1207 101 1207 101
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
Friday,September 30,2016
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—
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
IOU CAN RELY ON INVOICE
MW PIED ORIGINAL COPY Page: 1 of 1
Remittance Address
)RRESPONDENCE TO REORDERS CALL #1-800-527-9929 CERTIFIED LABORATORIES
1 BOX 2493 FAX #1-972-438-0634 23261 NETWORK PLACE
'WORTH TX 76113-2493 CHICAGO,IL 60673-1232
W W.CERTIFIEDLABS.COM
Sold To Ship To
ALttn: ACCOUNTS PAYABLE Attn: RUSSELL PICKETT Sign up to receive your
next invoice via email
BROOKSHIRE GOLF COURSE BROOKSHIRE GOLF COURSE
12120 BROOKSHIRE PKWY 12120 BROOKSHIRE PKWY or pay your next invoice
CARMEL IN 46032
CARMEL IN 46032 ach/eft/direct deposit
simply email us at
cac.credit@nch.com
Customer No. Billing Date Terms Due Date Ship Date Sales Order
588252 21-SEP-16 10 NET 01-OCT-16 21-SEP-16 2668859
Invoice No. Purchase Order No. Sales Rep.No.. Sales Rep.Name
2460783 SHOP USCL223T PARAMSKI,Mr.DAVID PATRICK(DAVE)
Product Q Ordered Description IPackagingl QtyBilled I Unit Price Amount
12054827 1 LOK-CEASE 20/20 BRUSH TOP,1/2 DZ,NAC MM DZ2 1.00 166.85 166.85
Merchandise I State Tax I Local Tax *" Shipping Split Inv.No. Currency Total Amount
166.85 0.00 0.00 0.00 I USD 166.85
IN Tax ID#0003512371-001-3 Federal ID#75-0457200
CERTIFIED LABORATORIES,DIVISION OF NCH CORPORATION.ALL RETURNS CLAIMS FOR ERRORS,OR ADJUSTMENTS OF ANY KIND MUST
BE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS.MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR WRITTEN
..,,,,.V—, **07DirrrnM cPuvrrFc wri ring CT-TIPPING&HANDLING CHARGES–F.O.B.INDIANAPOLIS.