190223 09/29/2010 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
«o CHICAGO IL 60673 -1232 CHECK NUMBER: 190223
CHECK DATE: 9/2912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 633631 200.29 BUILDING REPAIRS MA
ORIGINAL
CK M -AgUA INVOICE
We Treat Your water Rights CHEMAQUA
REORDERS CALL: :1- 800 -527 -9921 23261 NETWORK PLACE
CORKESPONDEINCP 7'0:
P.O. BOX 152170 FAX 1- 972 -438 -0634 CHICAGO, IL 60673 -1232
1RVLNC, TEXAS 75015
www.CHEMAQUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
3 CIVIC SQ payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032 To enroll please call
CARMEL IN 46032
1- 800 527 9919- x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms Sales Rep I Order No. I Ship Date I Customer P.O. No.
CB002439 633631 09 -16 -10 NET 10 DAYS 7C34 07131 09 -15 -10
Product Packaging Description Unit Price Qtv Billed Amount
X005 1 WATER TREATMENT PROGRAM 200.29 1EA 200.29
Merchandise I State Tax Local Tax Shitming I Inv. Total Amount
200.291 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 CF;EDIT WITHOUT OUR PRIOR
WRITTEN CONSENT_ DISTRIBUTION SERVICES INCLUDE SHIPPING 6 HANDLING CHARGES F_O.B. DELVD.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 264 (Rev. 1995)
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))
9/16/10 633631 monthly a ent 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 633631 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
September 24 20 10
Signature
Chief of Po ice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund