167595 01/07/2009 CITY OF CARMEL, INDIANA VENDOR: 194400 Page 1 of 1
0 ONE CIVIC SQUARE CHEM -AQUA, INC CHECK AMOUNT: $183.76
CARMEL, INDIANA 46032 23261 NETWORK PLACE
oN ,�o CHICAGO IL 60673 -1232 CHECK NUMBER: 167595
CHECK DATE: 1/7/2009
DEPA ACCOUNT PO NUMB INVO NUMBER A DESCRIPTION
1110 4350100 530776 183.76 BUILDING REPAIRS MA
0.
ORIGINAL
CEEM-AgUA INVOICE
We Treat Your Water Right` REORDERS CALL: 1- 800 -527 -9921 CHEMAOUA
CORRHSPONnENCH TO: 23261 NETWORK PLACE
P.O. Box 152170 FAX 1 -972- 438 -0634 CHICAGO. IL 60673 -1232
IRVIN`G, AAS 7,015
www.CliEMAOUA.coni
SOLD TO: SHIPPED TO:
Electronic Funds Transfer
CARMEL POLICE STATION (EFT)
CARMEL POLICE STATION 3 CIVIC SO payments are encouraged
3 CIVIC SQ CARMEL IN
46032
CARMEL IN 46032 To enroll please call
1- 800 -527- 9919 -x0831
Cust. Acct. No. Invoice No. I Invoice Date Terms ISales Rep I Order No. I Ship Date Customer P.O. No.
CB002439 530776 12 -19 -08 1 NET 10 DAYS 7C34 0711L 12 -18 -08
roduct acka ~in„ Description
p Unit Price Qty Billed Amount
X005 1 WATER TRTMT PROD /OR SVC 183.76 1 EA 183.76
Merchandise State Tax Local Tax ShiPpin° 111v. Total Amount
183.76
183.76
IN Tax 003512371 -001 -3 Federal Id #75- 2781907
CHEN -AQUA, INC., ALL RETURNS, CLAIMS FOR ERRORS OR ADJUSTMENTS OF ANY KIND
MUST HE MADE WITHIN 15 DAYS AFTER RECEIPT OF GOODS. MERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR
WRITTEN CONSENT. "DISTRIBUTION SERVICES INCLUDE SHIPPING 6 HANDLING CHARGES F,O,D. DELVD.
Prescrjbf;O by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Chem -Aqua Purchase Order No.
4 23261 Network Place Terms
Chicago, IL 60673 -1232 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12/19/08 530776 monthly payment 183.76
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
VO CHER NO. WARRANT NO.
ALLOWED 20
Gnem —Aqua
IN SUM OF
23261 Network Place
Chicago, TL
183.76
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1110 530776 501 183.76 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
January 2 20 09
k A aa b
Signature
('hi_ef of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund