166623 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC CHECK AMOUNT: $183.76
CARMEL, INDIANA 46032 23261 NETWORK PLACE
CHICAGO IL 60673 -1232 CHECK NUMBER: 166623
CHECK DATE: 12/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 524832 183.76 BUILDING REPAIRS MA
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ad' ORIGINAL
C1 EMLl4►UA INVOICE
7.0
We Treat Your Water Right' REORDERS CALL: 1 -800 -527 -9921 CHEMAOiJA
CORRESPONDENCE TO: 23261 NETWORK PLACE
P.O.nax 152170 FAX 1- 972 -438 -0634 CHICAGO. IL 60673 -1232
nivwc, rEx As ants www.CI EMAOUA.coni
SOLI) TO: SKIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
3 CIVIC SO payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SQ 46032
CARMEL IN 46032 Co enroll please call
1- 800 -527- 9919 -x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms Sales Rep Order No. I Ship Date Customer P.O. No.
CB002439 524832 11 -19 -08 NET 10 DAYS I 7C34 I 0711K 1 11 -18 -08
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 183,76 1EA 183.76
Merchandise State Tax Local Tax **Shipping Inv. Total Amount
183.76 1 1 1 583.76
IN Tax 003512371 -001 -3 Federal Id #75- 2761907
CHEM -AQUA, INC., ALL RETURNS, CLAIMS FOR ERRORS OR ADJUSTMENTS OF ANY RIND
MUST HE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS. MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR
WRITTEN CONSENT. —DISTRIBUTION SERVICES INCLUDE SHIPPING HANDLING CHARGES P.O.B. DELVD.
Prescr4ed 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))
11/19/08 524832 monthly payment 183.76
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
C hemAqua IN SUM OF
23261 Nettaork Place
Chicago, IL 60673- -1232
183.76
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
1110 524832 501 183.76 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
December 3 20 08
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund