213995 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 358238 Page 1 of 1
ONE CIVIC SQUARE LABCHEM INC CHECK AMOUNT: $68.79
CARMEL, INDIANA 46032 200 WILLIAM PITT WAY
PITTSBURGH PA 15238 CHECK NUMBER: 213995
CHECK DATE: 10/23/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 807985 68 . 79 OTHER EXPENSES
INVOICE
1UhChInvoice ID :8
em Sales Order ID :813529 13529
performance through chemistry Invoice Date : 9/27/2012
200 William Pitt Way,Pittsburgh,PA 15238 Ship Date : 9/27/2012 7:50:00 AM
Ph:412-826-5230 1 Fax:412-826-5234 Customer PO ID TARA
Page Number : 1 of I
AR Terms: Due Date: Amount Due:
Net 30 Days 10/27/2012 $68.79
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: 9/25/2012 11:41:02 AM FOB: Pittsburgh,PA
Packing Slip: 409216 Currency Type: USD
Ship Method: FedFx Ground Service
Line Nbr Item ID/Item Name Unit of Shipped Unit Price Sales Tax Extra Extended
Cust Item ID Measure Qty Charges Price
1 LC 177302/NITRIC ACID 10%V/V EA 1.0000 $33.0000 $0.0000 $33.00
RIO Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
8242-15 08/31/2014 1
Line Item Total: $33.00
Subtotal: $33.00
Sales Tax: $0.00
Tracking Numbers:
Shipping Charges: $35.79
015396465278620 Total: $68.79
Form#34.02 06/19/2012 See"www.labchem.com"for C ofA 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 10/17/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/17/201: 807985 $68.79
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 # 125927 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
807985 01-7202-05 $68.79
Voucher Total $68.79
Cost distribution ledger classification if
claim paid under vehicle highway fund