211069 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 360690 Page 1 of 1
0 ` ONE CIVIC SQUARE JOHN THOMAS
CARMEL, INDIANA 46032 11576 CREEKSIDE LANE CHECK AMOUNT: $28.93
« ?� CARMEL IN 46033 CHECK NUMBER: 211069
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
211 4462838 28 . 93 STORM WATER PHASE II
Fernandez, Rachel
From: Orders [orders @freshwatersystems.com]
Sent: Friday, June 29, 2012 1:43 PM
To: Fernandez, Rachel
Subject: FreshWaterSystems.com Receipt
FreshWaterSystems.com Receipt
***PLEASE PRINT RECEIPT OUT AND RETAIN IT FOR FUTURE REFERENCE***
Order Number: 347811 Check Order Status
Entail: rfernandez�carmel.in.gov (347811)
Date: 6/29/2012 1:42:26 PM
Account Billing Address Shipping Address
Name: Rachel Fernandez Rachel Fernandez
Company: City of Carmel City of Carmel
Address: One Civic Square 1 CIVIC SQ
Address: Engineering
Carmel, IN 460')2 CARMEL, IN 46032-2584
Phone: 317-571-2459 317-571-2459
Product Qty Each Sub Total
Pool Check® Phosphate (50/bottle) - 2 $11.99 $23.98
Part# 481349 .30
Estimated Weight: .60 lbs.
NOTE:iif your itenh(s)are on backorder,we will contact you via e-mail and/or phone to inform Subtotal: $23.98
you ofthe estnnated ship date,and/or other options. 117e promise to contact yon the some business Tax: $0.00
dm-for AIR shipments(until 6:30 PM EST)and within I business day(M-F)for ground
shipments. US Mail Shipping: $4.95
Total: $28.93
Paid by VISA ****9466
We use recycled packaging! Thank you for choosing FreshWaterSystems.com!
Return Police:Prior authorization required for returns and freight must be prepaid.Returns must be received within 30 days of original invoice date.Returns must be
unused and in the original packaging with all documentation.Orders that received free shipping are subject to a$9.95 fee or the actual shipping charge,whichever is
oreater.Shipping.Handling and Installation charges are not refundable.Returned Goods may be subject to a 15-25%restocking fee.
Zip=N,Addr—NV-1.00_U4F4_
1
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
John Thomas Purchase Order No.
Terms
Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s) Amount
6/29/2012 0 testing supplies for idde program $ 28.93
Total $ 28.93
1 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.
John Thomas ALLOWED 20
IN SUM OF $
$ 28.93
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
0 0 211-4462838 28.93 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
/18/2012
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund