168541 02/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00352337 Page 1 of 1
0 ONE CIVIC SQUARE INDUSTRIAL CHEM LABS SVCS CHECK AMOUNT: $119.21
CARMEL, INDIANA 46032 55 -G BROOK AVENUE
DEER PARK NY 11729 CHECK NUMBER: 168541
CHECK DATE: 2/4/2009
DEPARTMENT AC COUNT PO NUMBER INVOICE NUMB A MOUNT DESCRIPTION
651 5023990 47641 119.21 MATERIALS SUPPLIES
INDUSTRIAL CHEM. LABS C M
SERVICES INC.
55 G BROOK AVE DATE INVOICE
DEER PARK, NY 11729 -7200
PH: 800-827-0869 1/8/2009 47641
f
BILL TO: SHIP TO:
CITY OF CARMEL SAME
ACCOUNTSPAYABLE
9609 HAZEL DELL PARKWAY- OFFICE
INDIANAPOLIS, IN 46280 -2935
P.O. TERMS REP SHIP VIA Ref
JEFF COOPER Net 30 CH 1/8/2009 UPS 31
25 LIFT STATION D... LIFT STATION DEGREASER 3.89 97.25
S H SHIPPING HANDLING 21.96 21.96
5119.21
VISA/ MASTERCARD ACCEPTED FOR EASY PAYMENT.
Payments /Credits $0.00
ALL SALES ARE FINAL
Balance Due $119.21
Phone Fax #'s Web Site
800 827 -0869 631 274 -3064 or 631-254-1597 www.chemlabs.info
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
352337
INDUSTRIAL CHEM LABS SVCS Purchase Order No.
55 -G Brook Avenue Terms
Deer Park, NY 11729 Due Date 1/28/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/28/2009 47641 $119.21
'hereby certify that the attached invoice(s), or bill(s) is (are) true and
)rrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date O ce
VOUCHER 087198 WARRANT ALLOWED
352337 IN SUM OF
INDUSTRIAL CHEM LABS SVCS
55 -G Brook Avenue
Deer Park, NY 11729
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
i
Al
Board members
PO INV ACCT AMOUNT Audit Trail Code
47641 01- 7202 -06 $119.21
Voucher Total $119.21
Cost distribution ledger classification if
claim paid under vehicle highway fund