165705 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
i CHECK AMOUNT: $183,76
CARMEL, INDIANA 48032 23261 NETWORK PLACE
pro CHICAGO IL 6067s -1232 CHECK NUMBER: 165705
CHECK DATE: 11/12/2008
DEPARTMENT A CCOU NT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 521289, 183.76 BUILDING REPAIRS MA
...,.E
ORIGINAL ttb n
CKM -AQUA INVOI
We Treat Your water Right* REORDERS CALL: 1- 800 -527 -9921 C FIEMAOUA
CORRESPONDENCE To: 23261 NETWORK PLACE
P.O. Box 152170 FAX 1 -972- 438 -0634 CHICAGO. IL 60673 -1232
IRVING, rEXAS75015 www.CHEMAOUA.com
;OLD TO: SHIPPED TO:
Electronic funds Transfer
(EFT)
CARMEL POLICE STATION
CARMEL POLICE STATION 3 CIVIC SQ payments are encouraged
CARMEL IN
3 CIVIC SO 46032 To enroll please call
CARMEL IN 46032
1 -800- 527 991.9 -x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms Sales Rep Order No. Ship Date Customer P.O. No.
CB002439 1 521289 10 -21 -08 NET 10 DAYS 704 07111 10 -20 -08
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 183.76 1 E 183.76
Merchandise State Tax Local Tax *Shipping I Inv. Total Amount
183.761 1 1 183.76
IN Tax 003512371 -001 -3 Federal id #75- 2761907
CHEM -AQUA, INC.. ALL RETURNS. CLAIMS FOR ERRORS OR ADJUSTMENTS OF ANY KIND
MUST BE MADE WITHIN 15 DAYS AFTER RECRIPT OF GOODS. MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR
WRITTEN CONSENT. "DISTRIBUTION SERVICES INCLUDE SHIPPING 6 BANDLING CHARGES F.O.B. DELVD.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (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 Net3work Palce Terms
Chicago, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10121/08 521289 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
Che&Aqua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
183.76
ON ACCOUNT OF APPROPRIATION FOR
police generl aufnd
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice (s), or
1110 521289 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
November 4 20 08
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund