188278 08/03/2010 *f CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
0 ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK AMOUNT: $200.29
iL,ro CHICAGO IL 60673 -1232
CHECK NUMBER: 188278
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUN PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
1110 4350100 622933 200.29 BUILDING REPAIRS MA
I ORIGINALµ:.:.
CHEMA6.UA INVOICE
We Treat Your water Right' REORDERS CALL: 1- 800 -527 -9921 CHEMAQUA
CORRESPOl\DENCETO: 23261 NETWORK PLACE
P.O. sox 152170 FAX 1- 972 438 -0634 CHICAGO, IL 60673 -1232
IR \'hCG, TEXAS 75015
www.CHEMAQUA.coni
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
3 CIVIC SO payments are encoura
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032 To enroll please call
CARMEL IN 46032
1 -8011` 527 9919 -x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms Sales Re o Order No. Shi v Date Customer P.O. No.
CB002439 622933 07 -16 -10 NET 10 DAYS 7C34 0713G 07 -15 -10
Product Packaging Description Unit Price Qtv Billed Amount
X0 0 5 1 WATER TREATMENT PROGRAM 200.29 1 EA 200.29
Merchandise State Tax Local Tax *Shi 1ingT 1 Inv. Total Amount
200.29 1 1 1 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 BE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS. MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR
WRITTEN CONSENT. DISTRIBUTION SERVICES INCLUDE SHIPPING 6 HANDLING CHARGES F.O.R. OFPm,
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))
7/16/10 622933 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. WARRANT NO.
ALLOWED 20
ChemAqua
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 622933 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
Jul.y 26 20 10
k j';tAAf P
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund