164186 09/30/2008 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 23261 NETWORK PLACE CHECK AMOUNT: $183.76
CHICAGO IL 60673 -1232
CHECK NUMBER: 164186
CHECK DATE: 9130/2008
DEPAR TMENT ACCOUNT PO..NUM I NVOICE NUM BER A MOUNT DESCRIPTION
1110 4350100 51'6371 183.76 BUILDING REPAIRS MA
0 s:
-I
ORIGINAL
CK QUA INVOICE
We Treat Your Water Right' REORDERS CALL: 1 -800- 527 -9921 CIIEMAOUA
CORRESPONDENCE-1-0: 23261 NETWORK PLACE
P.O. BOX 152170 FAX 1- 972 438 -0634 CHICAGO. IL 60673 -1232
IRv1NG,TEXAS 75015
www.CHEMAOUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
CARMEL POLICE STATION 3 CIVIC SO payments are encouraged
CARMEL IN
3 CIVIC SO 46032
CARMEL IN 46032 To enroll please call
1 -800 -527- 9919 -x0831
Cust. Acct. No. Invoice No. Invoice Date Terms Sales Rep Order No. Ship Date Customer P.O. No.
CB002439 516371 09 -19 -08 NET 10 DAYS 7C34 07111 09 -18 -08
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTNT PROD /OR SVC 183.76 1 E 183.76
Merchandise State Tax Local Tax *Shipping Inv. Total Amount
183.76 183.76
IN Tax 003512371 -001 -3 Federal Id #75- 2761907
CHEN -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 HANDLING CHARGES F.O.B. DELVD.
Presclted by State Board of Accounls 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
Chem —Aqua Purchase Order No.
23261 Net3work Place Terms
Chicago, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/19/08 516371 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
CheinAqua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
183.76
ON ACCOUNT OF APPROPRIATION FOR
police gen eral fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 516371 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
September 26 20 08
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund