185547 05/20/2010 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 CHECK AMOUNT: $200.29
23261 NETWORK PLACE
CHICAGO IL 60673 -1232 CHECK NUMBER: 185547
CHECK DATE: 5/20/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 607639 200.29 BUILDING REPAIRS MA
ORIGINAL
C -A A INVOIC
We Trod Your wmor Right' REORDERS CALL: 1 -500- 527 -9921 CHEMAQUA
CORRESPONDENCE T 0: 23261 NETWORK PLACE
P.O, BOX 152170 FAX 1- 972 -438 -0634 CHICAGO, IL 60673 -1232
IRViNG, TF,XAS 75015 www.CHEMAQUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
CARMEL POLICE STATION (EFT)
3 CIVIC SO payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032 To enroll please call
CARMEL IN 46032
1-8 00- 5 27- 9919 x O8 31
.Gust. Acct No. Invoice No. Invoice Date Terms Sales Rev Order No. Ship Date Customer P.O. No.
08002439 667639 04 16 10 NET 10 DAYS I C34 0713D 04 15 1 6
Product Pac kadug Descri tion Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD s /OR SVC 200.29 1 X 200.29
Merchandise State Tax Local Tax "Shinning Inv. Total Amount
200.26 200.29
IN Tax #0101 Federal Id# 75- 2761907
CFkM -AQUA, INC., ALL RETURNS, CLAIMS.. FOR ERRORS OR ADMSr.ENTS OF ANY RIND
MUST BE FADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS, 1S"CHANDISE NOT ACCEPTED FOR CFEDTT, WITHOUT Olaf PRIOR
WRITTM; WVUENT. eTBTP.IRM1014 SERVIMS INCLUDE SHIPPING c HANDLING CHARGES F.O.H. DEtHD.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (Rev. 1395)
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
CHemA9ua Purchase Order No.
23261 Network Place Terms
Chicago, TL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4 1 0 60763 monthly payment
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
VUUUr1tN NU. MV Arlr M1 1 IVU
ALLOWED 20
ChemAaua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
200.29
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
1110 607639 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
April 27 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund