174268 07/08/2009 CITY OF CARMEL, INDIANA VENDOR. 194400 Page 1 of 1
ONE CIVIC SQUARE CHEM -AQUA, INC
0 CHECK AMOUNT: $200.29
CARMEL, INDIANA 46032 23261 NETWORK PLACE
CHICAGO IL 60673 -1232 CHECK NUMBER: 174268
CHECK DATE: 7/8/2009
DEPARTMEN ACCOUNT PO NUMBER INV OICE NUMBER AMOUNT DESCRI
1110 4350100 557915 T 200.29 BUILDING REPAIRS MA
L ORIGINAL f m i.: ;s SW
a 0 CRM -AAA INVOICE
We Treat Your Water Right' REORDERS CALL: 1 -800 -527 -9921 CH EMAQUA
C01ZR1 ?S1'0N1)ENU TO: 23261 NETWORK PLACE
I'.o, BOX 152170 FAX 9 1- 972 -438 -0634 CHICAGO, IL 60673 -1232
IRVING.TEXAS 75015
www.CE- 1EMAQUA.com
SOLD TO: SH 1 PPED TO:
Electronic Funds Transfer
(EF -r)
CARMEL POLICE STATION
CARMEL POLICE STATION 3 CIVIC SO payments are encouraged
CARMEL IN
3 CIVIC SQ 46032
CARMEL IN 46032 To enroll please call
1- 800 -52 7 -9919 -x0831
Cust. Acct. Na. tnvoice No. Invoice gate Terns Sales Rep Order No. Ship Date Customer P.O. No.
CB002439 557915 06 -16 -09 NET 10 DAYS 704 0712F 06 -15 -09
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 200.29 1 EA 200.29
Merchandise State Tax Local `rax *Shipping Inv. Total Amount
200.29 1 200.29
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)
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, TL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/16/09 557915 monthly payment 200.29
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 hemAclua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232
200.29
ON ACCOUNT OF APPROPRIATION FOR
po general?_fnd
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 557915 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
June 30 2009
&�"X I 74",
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund