219269 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 00352978 Page 1 of 1
ONE CIVIC SQUARE CHEMSEARCH
CARMEL, INDIANA 46032 CHECK AMOUNT: $602.67
23261 NETWORK PLACE
CHICAGO IL 60673-1232 CHECK NUMBER: 219269
CHECK DATE: 4/2412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 1051928 602 . 67 OTHER EXPENSES
CHEMSEV.FZCH-m- INVOICE Page: 1 of 1
CORRESPONDENCE TO
ORIGINAL COPY Remittance Address
PO BOX 152170 CHEMSEARCHFE
IRVING TX 75015 REORDERS CALL #1-800-527-9921 23261 NETWORK PLACE
FAX #1-972-438-0634 CHICAGO,IL 60673-1232
W W W.CHEMSEARCHFE.COM
Sold To Ship To We are going green!
Attn: ACCOUNTS PAYABLE
CITY OF CARMEL To pay electronically or
CITY OF CARMEL UTILITIES / OPERATIONS
UTILITIES FOREMAN receive invoices via
3450 W 131ST ST 4915 E 106TH ST
WESTFIELD IN 46074
CARMEL IN 46033 email or fax
simply contact us at
cac.credit @nch.com
Customer No. Billing Date Terms Due Date Ship Date Sales Order
441468 27-MAR-13 10 NET 06-APR-13 27-MAR-13 1102438
Invoice No. Purchase Order No. Sales Rep.No. Sales Rep.Name
1051928 DAN 032613A USFEF001 DUNSCOMB,Mr.JAMES L
Product I Qty Ordered Description -- PSckaging" Qty?Billed' Quit Price'-- —amount---
12019093 1 DEPLOY AEROSOL.DZ,NAC NC DZ 1.00 182.00 182.00
10186249 1 CONQUEST, 12 X 32 OZ.DZ.US NC DZ 1.00 393.00 393.00
Merchandise State Tax Local Tax rr Shipping Split Inv.No. Currency Total Amount
575.00 0.00 1 0.00 27.67 USD 602.67
IN Tax ID#0003512371-001-3 Federal 1D#75-0457200
_ CHEMSEARCII FE.DIVSION OF NCH CORPORATION,ALL RETURNS CLAIMS FOR ERRORS.OR ADJUSTNIE-NTS OF ANY KIND MUST BE MADE
-- WITHIN 15 DAYS AFTER RECEIPT OF GOODS NIERCHANDISE NOT ACCEPTED FOR CREDIT WITHOUT OUR PRIOR WRITTEN CONSENT. —
DISTRIBUTION SERVICES INCLUDE SHIPPING&HANDLING CHARGES—1'.O.B.INDIANAPOLIS.
------------------------------------ -- ---------------- ---------- ---------------------------------------------------- �r a
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
352978
CHEMSEARCH Purchase Order No.
23261 NETWORK PLACE Terms
CHICAGO, IL 60673-1232 Due Date 4/15/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/15/2013 1051928 $602.67
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 # 131345 WARRANT # ALLOWED
352978 IN SUM OF $
CHEMSEARCH
i
23261 NETWORK PLACE
CHICAGO, IL 60673-1232
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1051928 01-6200-04 $602.67
Voucher Total $602.67
Cost distribution ledger classification if
claim paid under vehicle highway fund