181145 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
1.` 0 ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK AMOUNT: $200.29
"w, _�a CHICAGO IL 60673 -1232 CHECK NUMBER: 181145
CHECK DATE: 1/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 587887 200.29 BUILDING REPAIRS MA
ORIGINAL
-e Vie e s._�
CFEM -AAA INVOICE
We Treat Your Water Right` REORDERS CALL: 1 -800 -527 -9921 CHEMAQUA
CORRESPOND} \CE 10: 23261 NETWORK PLACE
r.o. BOX 152170 FAX 1- 972 -438 -0634 CHICAGO, IL 60673 -1232
IRVINC,'IF XAS 75015
www.CH EMAQUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARIVIEL POLICE STATION
3 CIVIC SO payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032
CARMEL IN 46 0 3 2 To enroll please call
1- 800 -52 7 -9919 -x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms Sales Rep Order No Ship Date Customer P.O. No.
CB002439 587887 I 12 -16 -09 NET 10 DAYS 7C34 0712L 12 -15 -09
Product_ Packaging 1 Description Unit Price Qty Rifled _1 Amount
X005 1 WATER TRTMT PROD /OR SVC 200.29 1 EA 200.29
Merchandise State Tax Local 'fax *Shipping Inv. Total Amount
200.29 200.29
IN Tax 0101073755 -001-0 Federal Id #75- 2761907
CHEH -AQUA, INC., ALL RETURNS, CLAIMS FOR ERRORS OR ADJUSTMENTS OF ANY KIND
MUST HE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS. MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR
WRITTEN CONSENT. •'DISTRIBUTION SERVICES INCLUDE SHIPPING HANDLING CHARGES F.O.B. DELVD.
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
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
ChemAqua Purchase Order No.
23261 Network Place Terms
Chicago, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/16/09 587887 monthly payment 200.29
Total
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
V UCHER NO. WARRANT NO.
ALLOWED 20
C cinAqua IN SUM OF
23261 NEtwork Place
Chicago, IL 60673 -1232
200.29
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
O# or INVOICE NO. ACCT #!TITLE AMOUNT 1 hereby o y certify that the attached invoice(s), or
1110 587887 501 200.29 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
January 6 20 10
_______X;itimi_t) I
Signature
Chief of POlice
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund