216785 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 358238 Page 1 of 1
{ ONE CIVIC SQUARE LABCHEM INC CHECK AMOUNT: $261.87
CARMEL, INDIANA 46032 200 WILLIAM PITT WAY
PITTSBURGH PA 15238 CHECK NUMBER: 216785
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 816106 261 . 87 CHEMICALS
INVOICE
�,ab C h e f n Invoice ID :816106
Sales Order ID :822248
performance through chemistry Invoice Date : 1/2/2013
200 William Pitt Way,Pittsburgh,PA 15238 Ship Date 1/2/2013 2:11:00 PM
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 2/1/2013 $261.87
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: 1/2/2013 1:32:22 PM FOB: Pittsburgh,PA
Packing Slip: 417508 Currency Type: USD
Ship Method: FedEx 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 148451/GLUCOSE-GLUTAMIC ACID EA 4.0000 $33.0000 $0.0000 $132.00
B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Otv
B303-13 11/29/2014 4
Line Item Total: $132.00
2 LC226002/SILVER NITRATE,0.0141N(0.0141 M) EA 3.0000 $36.2000 $0.0000 $108.60
B/O Qty: 0.0000
Lot Number Expiration Date Lot Trans Oty
B354-09 06/28/2014 3
Line Item Total: $108.60
Subtotal: $240.60
Tracking Numbers:
Sales Tax: $0.00
Shipping Charges: $21.27
015396465323351,015396465323344 Total: $261.87
Form#34.02 06/19/2012 See"www.labchem.com"for C of A and MSDS information All Products Made In USA
VOUCHER # 126537 WARRANT # ALLOWED
358238 IN SUM OF $
LABCHEM INC
200 WILLIAM PITT WAY
;j
PITTSBURGH, PA 15238
t
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
816106 01-7182-05 $261.87
1
I
Voucher Total $261.87
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
358238
LABCHEM INC Purchase Order No.
200 WILLIAM PITT WAY Terms
PITTSBURGH, PA 15238 Due Date 1/23/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/23/2013 816106 $261.87
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
Date Officer