186247 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK AMOUNT: $200.29
CHICAGO IL 60673 -1232 CHECK NUMBER: 186247
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 612793 200.29 BUILDING REPAIRS MA
.j
�1
ORIGINAL#
0:
CKM AQ„A INVOICL
we Treat Your Water Right' REORDERS C ALL: 1- 800 -527 -9921 CHEMAQUA
CORRRSPONDENCETO: 23261 NETWORK PLACE
P.O, BOX 152170 FAX I- 972 -438 -0634 CHICAGO, IL 60673 -1232
TRVTNG, TEXAS 75015
www.CHEMAQUA. cam
�TSOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
3 CIVIC SO payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032
To enroll please call
CARMEL IN 46032
1 -800- 527 -991.9 -x0831
Cust. Acct. No, Invoice No. I Invoice Date Terms Sales Re 1 Order No. Ship Date Customer P.O. No.
013002439 j 612793 05 18 10 NET 10 DAYS 7C34 0713E I 05 17 10
Product Pacl"Igino
Descri Unit Price Qtv Billed Amount
X005 1 WATER TREATMENT PROGRAM 200.29 1 EA 200.29
Merchandise State Tax Local Tax *Shi )ina I Inv. Total Amount
200.29 1 200.29
IN Tax #0101073755-001-0 Federal Id# 75- 2761907
CHEM -AQUA, INC., ALL RETURNS, CLAIMS FOR ERRORS OR ADJUSTMENTS OF ANY KIND
MUST SE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOCDS. ERCHANDISE NOT ACCEPTED FOR CRE'.DIT WITHOUT OUR PRIOR
__WRITTEN CONSENT. '.'.DISTRIBUTION SERVICES INCLUDE; SHIPPING 5 HANDLING CHARGES E.O.B. DEUVD.
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
Chem —Aqua Purchase Order No.
23261 Network Place Terms
Chicago, IL 60673 -1'232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5/18/10 612793 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
VOUCHER NO. e WARRANT NO.
ALLOWED 20
ChenAqua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
200.29
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 612793 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
June 3 20 10
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund