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177604 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 358403 Page 1 of 1 ONE CIVIC SQUARE CHARDON LABORATORIES INC CHECK AMOUNT: $343.00 ;o CARMEL, INDIANA 46032 PO Box 1004 ACCT RECV CHECK NUMBER: 177604 COLUMBUS OH 43216 -1004 CHECK DATE: 912912009 DEPARTMENT ACC PO NUMBER INVOICE NUMBER AMOUNT DESC 651 5023990 10038223 343.00 OTHER EXPENSES F CHAR©ON LABORATORIES INVOICE' Corporate Service Research. Center Invoice No. 10038223 7300 Tussing Road Order No, 00012783 Reynoldsburg, Ohio 43068 Shipper ID S0039244 1.800.848.9526 Fax: 614.759.2558 Web: www.chardonlabs.com ACCOUNTS PAYABLE JEFF COOPER CARMEL WWTP CARMEL WWTP 9609 HAZEL DELL PARKWAY 9609 HAZEL DELL PARKWAY INDIANAPOLIS, IN 46280 INDIANAPOLIS, IN 46280 To include the applicable chemicals service outlined in Schedule 12 for Cooling Towers, Schedule 13 for Steam Boilers and/or Schedule 14 for Closed Systems. For detailed information on these schedules, please see you Master Service Agreement. SALES PERSON CUSTOMER NO. INVOICE DATE' CUSTOMER P.O. NO. TERMS VERBAL JEFF C NET 30 207404 918!2009 N O 1-DESCRIPTION PRICE SN10.05 SN -10 5 GALLON 220.00 1.00 220.00 ZTIMEMAT TIME AND MATERIALS FOR INSTALLATION TESTING 105.00 1.00 105.00 REMIT TO: CHARDON LABORATORIES, INC. Sales Total 325.00 ACCOUNTS RECEIVABLE DEPT 1 —A P.O. BOX 1004 COLUMBUS, OHIO 43216 -1004 Shipping Handling 18.00 Misc, Charges 0.00 We hereby certify that goods used in conjunction with these services were produced in compliance with all applicable Tax Total 0.00 requirements of Sections 6, 7 and 12 of the Fair Labor Standards Act, as amended and on regulation and orders of the 343.00 United States Department of Labor issued under Section 14, thereof. Less Paid Amount 0.00 Afinance charge of 1.5% per month, 18% annum, will be added to overdue invoices. 343.00 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 358403 CHARDON LABORATORIES INC Purchase Order No. 16121 CHANCELLORS RIDGE WAY Terms ik NOBLESVILLE, IN 46062 Due Date 9/17/2009 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/17/2009 10038223 $343.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Officer VOUCHER 096423 WARRANT ALLOWED 358403 IN SUM OF CHARDON LABORATORIES INC t-8 424 2 N"C ='ELtO P-0 6$ 62 P o` uo.X_l o a Y .CdA.. s o /f '/-3.2 Carmel Wastewater Utility r ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 10038223 01- 7362 -05 6343.00 Voucher Total $343.00 Cost distribution ledger classification if claim paid under vehicle highway fund 1