191720 11/10/2010 CITY OF CARMEL, INDIANA VENDOR: 363758 Page 1 of 1
0 ONE CIVIC SQUARE LABSOURCE
CARMEL, INDIANA 46032 97400 EAGLE WAY
CHECK AMOUNT: $310.00
CHICAGO IL 60678 -9740
CHECK NUMBER: 191720
CHECK DATE: 11/10/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 810642 310.00 OTHER EXPENSES
Remit To
LABSOURCE, INC
97400 Eagle Way
Chicago, IL 60678 -9740 LabSource
PH: 800 -545 -8823 FAX: 630- 343 -1701 FEIN #36 3631684
Invoice 810642
Date 10/26/2010
PO# S12314
Bill To Ship To
City of Carmel City of Carmel
Tara Washington Tara Washington
Wastewater Lab Wastewater Lab
6909 Hazel Dell Pkwy 9609 Hazel Dell Pkwy
Indianapolis, IN 46280 Indianapolis, IN 46280
Customer Ship Via FOB Terms
CAR571 UPS Ground Commercial Destination NET 30 DAYS
Purchase Order Salesperson' p Order Date Sales Order
S12314 DC 1012212010 690832
Quantity
Line Ord Shi BO UOM Catalog Description Price Extended
0 CS N853 Gloves, Nitrile, Blue, Powder -Free, Textured, $62.00 $310.00
Large, 100/ k, 1000 /cs
Pkg 1- 1Z22E4360306679419
Pkg 2 1Z22E4360306679428
Pkg 3 1Z22E4360306679437 Subtotal $310.00
Pkg 4 1Z22E4360306679446 Shipping Handling $0.00
Pkg 5 1Z22E4360306679455
Invoice Total $310.00
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Page 1 of 1
VOUCHER 106510 WARRANT ALLOWED
363758 IN SUM OF
LABSOURCE
ROMEOVILLE, IL 60446
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
810642 01- 7202 -05 $310.00
�i
Voucher Total $310.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 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 11/312010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/3/2010 810642 $310.00
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