192408 12/07/2010 VENDOR: 194400
F CITY OF CARMEL, INDIANA Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
e l' CHECK AMOUNT: $200.29
CARMEL, INDIANA 46032 23261 NETWORK PLACE
CHICAGO IL 60673 -1232 CHECK NUMBER: 192408
CHECK DATE: 12/7/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 644441 200.29 BUILDING REPAIRS MA
m E E� Ell
st;'�is�ssssi „�.M...i'„„
ORIGINAL1�
CKMAAQUA INVOICE
We Treat Your Water Right" REORDERS CALL: 1- 800 527 -9921 CHEMAQUA
CORRESPOiVDENCETO: 23261 NETWORK PLACE
t>.0. BOX 152170 FAX 1.- 972 438 -0634 CHICAGO, IL 60673 -1232
1t6`E \C, TEXAS 7
www.CHEMAQUA.com
SOLD 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 )919 -x0831
Cust. Acct. No. Invoice No. Invoice Date Terms Sales Rev Order No. Ship Date Customer P.O. No.
CB002439 644441. 1 1 16 10 NET 10 DAYS 7C34 0713K 11
Product Packaging Descri rtion Unit Price Qtv Billed Amount
X0 0 5 1 WATER TREATMENT PROGRAM 200.29 1 EA 200.29
Merchandise State Tax Local Tax *Shi v ling Inv. Total Amount
200.291 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.B. DELVD.
VOUCHER NO. WARRANT NO.
ALLOWED 20
Chem -Aqua
IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
$200.29
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1110 644441 43- 501.00 $200.29 1 hereby certify that the attached invoice(s), or
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
Thursday, December 02, 2010
Chief of Polic
Title
Cost distribution ledger classification it
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11/16/10 644441 monthly payment $200.29
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