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213109 09/25/2012 CITY OF CARMEL, INDIANA VENDOR: 365006 Page 1 of 1 ONE CIVIC SQUARE NALCO CROSSBOW WATER _• CHECK AMOUNT: $190.00 CARMEL, INDIANA 46032 NETWORK PLACE 24658 o� CHICAGO IL 60673 CHECK NUMBER: 213109 CHECK DATE: 9125/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 2089405 190 . 00 MATERIALS & SUPPLIES C RC)SS BC:)iV- Nalco Crossbow Water Invoice Network Place 24658 Chicago, IL 60673 USA Invoice No. 2089405 Customer No. 0310060A Bill To E Ship To CITY OF CARMEL WASTEWATER UTILITIES CITY OF CARMEL WASTEWATER UTILITIES 9609 Hazel Dell Parkway 9609 Hazel Dell Parkway Indianapolis, IN 46280 Indianapolis, IN 46280 Contact: Teresa Lewis Contact: Teresa Lewis T_elephone:_31.7-571-2634 210_ Telephone: 317-571-2634 210 Invoice Date OrderDatel SO Number Ordered By Customer PO Number Payment Method 09/14/12 1 09/04/12 1 Net 30 Warehouse Ship Via F.O.B. Salesperson Resale Number INDY Crossbow Truck Chris Coppock Order Ship Unit Extended Quantity Quantity Tax It Number/Description Price Price 2 2 Y DMDI U of M: EACH 95.0000 190.00 DI EXPRESS IT SERVICE EXCHANGER 01 D80 FRP MIXBED Print Date 09/14/12 Due Date 10/14/12 Subtotal 190.00 Print Time Freight 0.00 Page No, 1 Total Paid 0.00 Balance Due 190.00 invoice Total 190.00 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 365006 NALCO CROSSBOW WATER Purchase Order No. NETWORK PLACE 24658 Terms CHICAGO, IL 60673 Due Date 9/20/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/20/2012 2089405 $190.00 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 # 125734 WARRANT # ALLOWED 365006 IN SUM OF $ NALCO CROSSBOW WATER NETWORK PLACE 24658 CHICAGO, IL 60673 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 2089405 01-7202-05 $190.00 Voucher Total $190.00 Cost distribution ledger classification if claim paid under vehicle highway fund