212909 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 354047 Page 1 of 1
h 0 ONE CIVIC SQUARE AQUA SYSTEMS CHECK AMOUNT: $66.29
CARMEL, INDIANA 46032 7785 EAST US HIGHWAY 36
t row. AVON IN 46123 CHECK NUMBER: 212909
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 150286 66 . 29 OTHER EXPENSES
1 Q,A LUA - INVOICE
�® SI-2 80232
4r: 7785 East US Highway 36 Order No. 11511286 14, Written By y _ A� Order Date I ue. a, 1 I
Avon, IN146123 Account# 132605
800-447-5582 Technician Serv. Date No 0
s www.ilovemywater Bill to Account#
Df C&Irmel HHW Dept. Route 0 c�kence
Name
004, H Rangefina Rd.
Last Del.
Address
carmul im 46
City j
M7571-:2045
�_. Install Date Customer Installed
Phone#
f, Hardness gpg Iron ppm ph
Ordered By
TDS ppm Watertype
Requested Time
'x;,
NOT OPEN ON MONDAYS-TUES THRU SAT1.:1F NOT
Comments:
LEAVE AT CITY OF CARME ^�l1AJS� r�1��►T �A��
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' alien Aqua
8 D5AS Deposit 5 gallon Aqua
saute _. 0 - -6.00
RTN � al Aqua System"
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opt�dtaled Deliveri es Og/1919 2 Custorrtar Is non-taxable
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51 s�
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=� RENTAL WARRANTY..
CHARGE RETURN-
09/11/12 ,
_ HOURS RATE
Next Deliv ry Date ••-
,
! Service/Delivery Tech. •104
---.. - "t~
Customer Name-Please Print = . 5.20
Customer Signature
..
TAX
I hereby acknowledge..satisfactory compleiion'of above described.,work.
! 30 Day Labor Warranty Due Date j
-�— ----- ----- -----------------.------------- ----- ;l - --- ---- -- -
0II1-To Customer. 132505-Clly of Carmel Sewer Dept t +
AQUA
Please pay from this bill. No other billing will be mailed. Upon receipt of merchandise or services, customer agrees to pay in full by
! due date. If payment is not received,you are subject to collection fees, court costs and attorney fees.
i;
e ' Below is your account balance and aging as of the order date above. This balance does not reflect today's service or delivery.
t� Your prompt payment would be greatly appreciated.
t ,q
Current Up to 30 Days 31-60 Days Over 60 Days Balance Due
` 0.00 0.00 0.00 0.00 0.00
VOUCHER # 125766 WARRANT # ALLOWED
354047 IN SUM OF $
AQUA SYSTEMS
7785 EAST US HIGHWAY 36
AVON, IN 46123
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
150286 01-720H-08 $66.29
Voucher Total $66.29
Cost distribution ledger classification if
claim paid under vehicle highway fund
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
354047
AQUA SYSTEMS Purchase Order No.
7785 EAST US-HIGHWAY 36 Terms
AVON, IN 46123 Due Date 9/20/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/20/2012 150286 $66.29
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
91///,,
Date Officer