186401 06/09/2010 CITY OF CARMEL, INDIANA VENDOR: 363758 Page 1 of 1
ONE CIVIC SQUARE LABSOURCE
CARMEL, INDIANA 46032 CHECK AMOUNT: $493.26
97400 EAGLE WAY
CHICAGO IL 60678 -9740 CHECK NUMBER: 186401
CHECK DATE: 6/9/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 797313 493.26 MATERIALS SUPPLIES
Remit To
LABSOURCE, INC
97400 Eagle Way
Chicago, IL 60678 -9740 La PH 800- 545 -8823 FAX: 630 343 -1701 FEIN #36 3631684
Invoice 797313
Date 05112/2010
PO# S 12152
Bill To Ship To
City of Carmel City of Carmel
Tara Washington Tara Washington
Wastewater Lab Wastewater Lab
9609 Hazel Dell Pkwy 9609 Hazel Dell Pkwy
Indianapolis, IN 46280 Indianapolis, IN 46280
Customer Ship Via FOB Terms
CAR571 UPS Ground Commercial Origin NET 30 DAYS
Purchase Order Salesperson Order Date Sales OrcSer'#
S12152 AF 05/11/2010 680043
Line Ord Q Ship BO UOM Catalog Description Price Extended
1 1 0 1 EA 1 302 32 DO PROBE MAINT KI $11 5.00 $0.00
2 2 0 2 EA 13 483 AMMONIA PH ADJUST ISA $61. 0.00
3 1 1 0 EA C65 -109 Trip Purpose T im er $14.00 $14.00
4 2 _0 2 PK 13- 297 -20 POLYSEED C 50 /PK
r 5. 10 10 Q PK P22 -272 Finnti 10m1, Bulk, Bagge 1 0Q /pk $17 .50 $175.00
5 0 5 RK AP4 GLA SS FIBER FILTER 47MM 10OPK T $39.69 $0 .00
j 7_ 2 2 0 PK M -221 Co G 22X2 #1_1oz/ 10oz_ /_cs _$7.00
j 8 3 0 3 PR_ 1485 -22_ HYDR_ION R 1 -12 5 /PK $7.08 $0.00
9. 6 0 6 EA 04 -355 -4 DRI CONTR P DETERG 2KG $3 4.55 $0.00
10 4 4 0 CS N853 Gloves, Nitrile, Blue, Powder -Free, Textured, $62.00 $248.00
Large l00 /pk, 100
11 4 0 4 PK 8909044 -PK CYLN G TD CLSA 10 P K1 $20.00 $0.00
12 1 0 1 EA 13- 642 -545 PHIATC EPDXY GEL TRIOBE $181.00 $0.00
Pkg1- lZ22E4360306487724
Pkg 2- 1Z22E4360306487733
Pkg 3- 1'Z22E43b03U64u774 Subtotal $451 W_
Pkg 4 1Z22E4360306487751 Shipping Handling $42.26
Pkg 5 1 Z22E4360306487760
Invoice Total $493.26
Page 1 of 1
VOUCHER 105541 WARRANT ALLOWED
363758 IN SUM OF
LABSOURCE �7y00
ARB'0TZ=E)R -E
A9 d 606 7;
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
797313 01- 7202 -05 $451.00
797313 01- 7202 -05 $42.26
Voucher Total $493.26
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No 201 (Rev 1995j"
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show, kind of service, where
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
363758
LABSOURCE Purchase Order No.
1186 ARBOR DRIVE Terms
ROMEOVILLE, IL 60446 Due Date 5/25/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/25/2010 797313 $493.26
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
Date Officer