216759 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 366867 Page 1 of 1
ONE CIVIC SQUARE INTERSTATE CHEMICAL CO
CHECK AMOUNT: $110.75
PO BOX 931412
CARMEL, INDIANA 46032 CLEVELAND OH 44193
CHECK NUMBER: 216759
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 73998 110 . 75 MATERIALS & SUPPLIES
Customer Number INTERSTATE CHEMICAL CO. INVOICE
108437
PHONE (724) 981-3771 FAX (724) 981-8383 Date Invoice#
01/03/2013 73998
Date Shipped Order#
R INTERSTATE CHEMICAL CO., INC. 01/03/2013 45567
E PO BOX 931412
M CLEVELAND ,OH 44193-1573 Date Due:
I .
T 02/02/2013
T_
O
S CARMEL WASTE WATER TREATMENT S CARMEL WASTE WATER TREATMENT
0 9609 HAZEL DELL PARKWAY H 9609 HAZEL DELL PARKWAY
L INDIANAPOLIS, IN 46280- 1 INDIANAPOLIS, IN 46280-
D P
T T
O O
Customer PO#— - --.---— FOS Remark- _ _ Freight Charges-- Vendor-
Code-S13431 DESTINATION PREPAID
Requisition# Payment Terms Ship Via Sales ID
NET 30 ALPONT LTL 610
Units Package Description Total Quantity Unit Price Amount
1.00 5 Gal PAIL INTERCOOL P-300 5.0000/Gal _ 12.5500 $ _ 62.75
22880-5S /Gal
Lot:22880-5S-02013H
SALES TAX EXEMPT 0.00
FUELSURCHARGE 48.00
Seller represents that with respect to the production of the articles andor the services covered by this invoice,it has fully complied with the
provisions of the Fair Labor Standards Act of 1938,as amended Total: $ 110.75
PRICE EFFECTIVE ON DATE OF SHIPMENT AND PRODUCT SUBJECT TO AVAILABILITY AT TIME (PLEASE PAY THIS AMOUNT)
OF SHIPMENT UNLESS OTHERWISE AGREED TO IN ADVANCE IN WRITING.
A LATE FEE OF 1 1/2%PER MONTH(18%PER ANNUM)WILL BE APPLIED TO ALL LATE PAYMENTS
Page 1 of 1
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
366867
INTERSTATE CHEMICAL CO. Purchase Order No.
PO BOX 931412 Terms
CLEVELAND, OH 44193-1573 Due Date 1/24/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/24/2013 73998 $110.75
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
VOUCHER# 126553 WARRANT # ALLOWED
366867 IN SUM OF $
INTERSTATE CHEMICAL CO.
PO BOX 931412
CLEVELAND, OH 44193-1573
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
73998 01-7202-06 $110.75
Voucher Total $110.75
Cost distribution ledger classification if
claim paid under vehicle highway fund