163524 09/04/2008 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
t ONE CIVIC SQUARE CHEM -AQUA, INC CHECK AMOUNT: $183.76
CARMEL, INDIANA 46032 23261 NETWORK PLACE
CHICAGO IL 60673.1232 CHECK NUMBER: 163524
CHECK DATE: 9/4/2008
`DEPART ACCOUNT PO NU INV NUM AMOUN DE SCRIPTION�
1110 4350100 511532 183.76 BUILDING REPAIRS MA
C!S
I
ORIGINAL n
CFEMAQUA INVOICE
We Treat Your WoterRight' REORDERS CALL: 1 -800- 527 -9921 CIlEMAOUA
CORRESPONOENCETO: 23261 NETWORK PLACE
P,O, ROX 152170 FAX 1- 972 -438 -0634 CHICAGO, IL 60673 -1232
1RVINC, TEXAS 75015 www.CHEMAOUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
3 CIVIC SQ payments are encouraged
CARMEL POLICE STATION CARMEL IN
3 CIVIC SO 46032
CARMEL IN 46032 To enroll please call
1- 800 -52 7- 9919 -x0831
Cust. Acct. No. invoice No. I Invoice Date Terms Sales Rep I Order No. Ship Date Customer P.O. No.
CB002439 1 511532 08 -19 -08 NET 10 DAYS 7C34 0711H 08 -18 -08
Product Packaging Description Unit Price Oty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 183.76 1 EA 183.76
Merchandise State Tax Local Tax *Shipping Inv. Total Amount
183.761 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 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 F.O.B. DELVD.'
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
j 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
ChemAgua Purchase Order No.
23261 Netowrk Place Terms
Chicago, TL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8119/08 511532 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 Network Place
Chicago, IL 60673 -1232
183.76
ON ACCOUNT OF APPROPRIATION FOR
p olice g eneral fund
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 511532 501 1 183.76 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
August 25 2008
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund