212282 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 358238 Page 1 of 1
0 ONE CIVIC SQUARE LABCHEM INC
CARMEL, INDIANA 46032 200 WILLIAM PITT WAY
CHECK AMOUNT: $262.97
'fir• PITTSBURGH PA 15238
CHECK NUMBER: 212282
CHECK DATE: 8/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 803880 262 . 97 MATERIALS & SUPPLIES
INVOICE 01'-)a 0 a 'OS
E ^ h Che a—LT��, Invoice ID :803880
((�O�O�lff, j( Sales Order ID :809271
performance through chemistry Invoice Date :8/16/2012
200 William Pitt Way,Pittsburgh,PA 15238 Ship Date :8/16/2012 8:13:00 AM
Ph:412-826-5230 1 Fax:412-826-5234 Customer PO ID :S13204
Page Number :Page I of 2
AR Terms: Due Date: Amount Due:
Net 30 Days 9/15/2012 $262.97
Bill To: 1265 Ship To
CARMEL WWTP CARMEL WWTP
ATTN: ACCOUNTS PAYABL 9609 HAZEL DELL PKWY
760 3RD AVE SOUTHWEST INDIANAPOLIS, IN 46280-2935
SUITE 110 USA
CARMEL,IN 46032
USA
Order Date: 8/15/2012 12:26:35 PM FOB: Pittsburgh,PA
Packing Slip: 405073 Currency Type: USD
Ship Method: FedEx Ground Service
Line Nbr Item ID/Item Name Unit of Shipped Unit Price Sales Tax Extra Extended
Cost Item ID Measure Qh Charges Price
l LC148451/GLUCOSE-GLUTAMIC ACID EA 4.0000 $31.5000 $0.0000 $126.00
B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
B 171-05 07/02/2014 4
Line Item Total: $126.00
2 LC226002/SILVER NITRATE,0.0 14 1 N(0.0141 M) EA 2.0000 $34.6000 $0.0000 $69.20
B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
B093-26 10/05/2013 2
Line Item Total: $69.20
3 LC 188501 /POTASSIUM CHROMATE INDICATOR EA 1.0000 $16.2000 $0.0000 $16.20
B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
B151-04 06/0V2014 1
Line Item Total: $16.20
4 LC179401/AMMONIA(as NITROGEN)STANDARD, EA 1.0000 $25.5000 $0.0000 $25.50
1000ppm(as N) B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
B136-05 05/16/2014 1
Line Item Total: 525.50
Farm#34.02 06/19/2012 See"www.labchem.com"for C of A and MSDS information All Products Made In USA
INVOICE
Es hCh em Invoice ID :803880
Sales Order ID :809271
performance through chemistry Invoice Date :8/16/2012
200 William Pitt Way,Pittsburgh,PA 15238 Ship Date :8/16/2012 8:13:00 AM
Ph:412-826-5230 1 Fax:412-826-5234 Customer PO ID :S13204
Page Number :Page 2 of 2
AR Terms: Due Date: Amount Due:
Net 30 Days 9/15/2012 $262.97
Bill To: 1265 Ship To
CARMEL WWTP CARMEL WWTP
ATTN: ACCOUNTS PAYABL 9609 HAZEL DELL PKWY
760 3RD AVE SOUTHWEST INDIANAPOLIS,IN 46280-2935
SUITE 110 USA
CARMEL,IN 46032
USA
Order Date: 8/15/2012 12:26:35 PM FOB: Pittsburgh,PA
Packing Slip: 405073 Currency Type: USD
Ship Method: Fed Ex Ground Service
Line Nbr Item ID/Item Name Unit of Shipped Unit Price Sales Tax Extra Extended
Cust Item ID Measure Qh Charges Price
Subtotal: $236.90
Sales Tax: $0.00
Tracking Numbers: Shipping Charges: $26.07
01 5396465258561,015396465258554,015396465258578 Total: $262.97
Form#34.02 06/19/2012 See"www.labchem.com"for C of A and MSDS information All Products Made In USA
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
358238
LABCHEM INC Purchase Order No.
200 WILLIAM PITT WAY Terms
PITTSBURGH, PA 15238 Due Date 8/21/2012
Invoice Invoice Description
Date Number (or,note attached invoice(s) or bill(s)) Amount
8/21/2012 803880 $262.97
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
Date Officer
VOUCHER # 125508 WARRANT # ALLOWED
358238 IN SUM OF $
LABCHEM INC
200 WILLIAM PITT WAY
PITTSBURGH, PA 15238
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
803880 01-7202-05 $262.97
Voucher Total $262.97
Cost distribution ledger classification if
claim paid under vehicle highway fund