169688 03/05/2009 F 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 60673 -1232 CHECK NUMBER: 169688
CHECK DATE: 3/5/2009
DEPA RTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 538699 200.29 BUILDING REPAIRS MA
ORIGINAL em1 an eSS 9
�?p 0, CKM-AgUA INVOICE
We Treat Your water Right' REORDERS CALL: 1- 800 -527 -9921 CHEMAOUA
CORRESPONDENCE To: 23261 NETWORK PLACE
P.O. BOX 152170 FAX 1- 972 -438 -0634 CHICAGO. IL 60673 -1232
IRVINC, TEXAS 75015 www. CHEMAOUA.com
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
(EFT)
CARMEL POLICE STATION
CARMEL POLICE STATION 3 CIVIC SQ payments are encouraged
CARMEL IN
3 CIVIC SQ 46032
CARMEL IN 46032 To enroll please call
1- 800 527 -9919 -x0831
Cus Acct. N o. Inv N o. I Inv Da te Terms Sales Rep I Order No. I Ship Date I Customer P.O. No.
CB002439 538699 02 -17 -09 NET 10 DAYS 7034 0712E 1 02 -16 -09
Product Packaging Description Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 200.29 1 E 200.29
Merchandise I State Tax Local Tax Shipping Inv. Total Amount
200.29 200.29
IN Tax 003512371 -001 -3 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 F HANDLING CHARGES F.O.B. DELVD.
Prescribed by Slate 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
ChemAgua 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))
2117/09 538699 p ayLnent 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.
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED
Cheri ua IN SUM OF
23261 Network Place
Chicago, IL 60673 -1232 I
11
200.29
11
ON ACCOUNT OF APPROPRIATION FOR
p olice general fund
Board Membl°
PO or �1
INVOICE NO ACCT #!TITLE AMOUNT
DEPT- 1 hereby certify that the attached involce(s), OI
1110 5538699 5011 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
February 25 20 09
&"a-b ad,
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund