308071 02/13/17 CITY OF CARMEL, INDIANA VENDOR: 055000
CHECK AMOUNT: $*******316.27*(9,
ONE CIVIC SQUARE CERTIFIED LABORATORIESCARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK NUMBER: 308071
CHICAGO IL 60673-1232 CHECK DATE: 02/13/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4350000 2596538 316.27 EQUIPMENT REPAIRS & M
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
Vendor# 055000 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
CERTIFIED LABORATORIES IN SUM OF$ CITY OF CARMEL
23261 NETWORK PLACE An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CHICAGO, IL 60673-1232
Payee
$316.27
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
2596538 43-500.00 $316.27 1 hereby certify that the attached invoice(s),or 1/25/17 2596538 Qwik Start $316.27
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
Monday, February 06,2017
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
YOU CAN RELY ON
CE /F/ED INVOICE
ORIGINAL COPY Page: 1 of 1
Remittance Address
CORRESPONDENCE TO CERTIFIED LABORATORIES
PO BOX 2493 ORDERS CALL #1-800-527-9929
Fr WORTH TX 76113-2493 FAX #1-972-438-0634 23261 NETWORK PLACE
CHICAGO,IL 60673-1232
WW.CERTIFIEDLABS.COM
Sold To Ship To
Attn: 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 25-JAN-17 10 NET 04-FEB-17 25-JAN-17 2822725
Invoice No. _ . :, ._ _ ___ .P.urchase Order,No-' ___ _:Sales Rep.No. = Sales Rep.-Name
_ - --
2596538 USCL223T PARAMSKI,Mr.DAVID PATRICK(DAVE)
Product Qty Ordered Description . Packaging I Qty Billed 1, Unit Price I Amount "
12053638 1 QWIK-START AEROSOL,DZ,US MM DZ 1.00
12060751 1 DURA-GARD AEROSOL,DZ,NAC MM DZ 1.00
Special System Price 288.00
Merchandise State Tax Local Tax ' Shipping Split Inv.No. Currency Total Amount
288.00 0.00 0.00 28.27 USD 316.27
IN Tax ID#0003512371-001=3' Federal 1D#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