177605 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
CARMEL, INDIANA 46032 CHECK AMOUNT: $200.29
23261 NETWORK PLACE
CHICAGO IL 60673 -1232 CHECK NUMBER: 177605
r' CHECK DATE: 9/29/2009
DEPA RTMENT ACCOUNT PO NUM BER INVOICE NU AMOUNT DE SCRIPTION
1110 4350100 572890 200.29 BUILDING REPAIRS MA
A r ORIGINAL, C� INVOICE
WeT,eat Your Water Right* REORDERS CALL: 1- 800 527 -9921 CHEMAQUA
CORRESPONDENCE TO: 23261 NETWORK PLACE
P.O. BOX 152179 FAX 1- 972 438 -0634 CHICAGO, IL 60673 -1232
IRVING, TEXAS 75015 www .CHEMAQU A.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 SQ 46032 To enroll please call
CARMEL IN 46032
1- 800 -527 -9919 -x0831
Cust. Acct. No. Invoice No. Invoice Date Terms Sales Rep Order No. Ship Date Customer P.O. No.
CB002439 1 -572890-- 1 09 -16 -09 NET 10 DAYS 7C3. 1 07 121 09 15 -09
Product P ackaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 200.29 1EA 200.29
Merchandise State Tax Local Tax *Sllippinjz 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 CONS=, aiLISTRIBUTION SERVICES INCL;%WE SHIPPING HANDLING CHARGES P.O.B. DELVD.
Prescribed by State Board of City Form No. 201 (Rev. 1995)
4 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
ChemAqua Purchase Order No.
23261 NEtwork Place Terms
Chicago, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
9/16/09 572890 monthly a ent 2
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.
n
ALLOWED 20
ChemAgua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
200.29
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PON or
DEPT. INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
1110 572890 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
September 25 20 09
*AiA1,Lb
Signature
Chief of Police
Title
Cost distribution ledger classification it
claim paid motor vehicle highway fund