179158 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC CHECK AMOUNT: $200.29
CARMEL, INDIANA 46032 23261 NETWORK PLACE
CHICAGO IL 6067 3 -1 232 CHECK NUMBER: 179158
CHECK DATE: 11/11/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 578010 200.29 BUILDING REPAIRS MA
a�
ORIGINAL emittance i4ddt
CRKAQUA INVOICE
We Treat Your Water Right* REORDERS CALL: 1- 800 -527 -9921 CI-IENIAQUA
CORRESPONDENCE 23261 NETWORK PLACE
P.O. BOX 152170 FAX 1 -972- 438 -0634 CIIICAGO, IL 60673 -1232
IRVING, TEXAS 75015 www.CHEMAQUA.coni
SOLD TO: SI- IIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
CARMEL POLICE STATION 3 CIVIC SO payments are encourab
CARMEL IN
3 CIVIC SQ 46032
CARMEL IN 46032 To enroll please call
1- 800 -52 7- 9919 -x0831
Cust. Acct. No. Ilrvoice No. I Invoice Date Terms Sales Rep Order No. Ship Date Customer P.O. No.
_.CB002439 _5780.10 10 -16 -09 NET 10 DAYS 704 0712J 10 -15 -09
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 200.29 1 EA 200.29
16 J
Merchandise State Tax Local Tax *Shipping Inv. Total Amount
200.29 200.29
IN Tax 0101073755 -001 -0 Federal Id #75- 2761907
CHEM -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.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
L ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
4n invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
vhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Chem Purchase Order No.
2 Netw Place Terms
C h i cag o, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/16/09 578010 monthly payment
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.
f
ALLOWED 20
C nemAqua
IN SUM OF
23261 Network Place
Chicago, IL
200.29
ON ACCOUNT OF APPROPRIATION FOR
police generla fund
Board Members
PC# or
DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 578010 501 200.29 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 09
Signature
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund