221265 06/18/2013 "'•F CITY OF CARMEL, INDIANA VENDOR: 00353237 Page 1 of 1
ONE CIVIC SQUARE TESTAMERICA INC
CARMEL, INDIANA 46032 PO BOX 122314 DEPT 2314 CHECK AMOUNT: $81.90
DALLAS TX 75312-2314
«o„ o CHECK NUMBER: 221265
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 24143926 81 . 90 OTHER EXPENSES
TestAmeri"ca
THE I,F,ADF,F. IN E,NVI i]NMENTc.I,Tr,STttJ :
Invoice/Credit No. 24143926 Invoice Date June 11,2013
Terms See Below Federal Tax ID 23-2919996
Remit to TestAmerica Laboratories,Inc.PO BOX 204290,Dallas,TX 75320-4290
Bill to: Ship to:
Carmel WWTP Carmel WWTP
Attn:Accounts Payable 9609 Hazel Dell Pkwy
9609 Hazel Dell Pkwy Indianapolis,IN 46280
Indianapolis,IN 46280
P.O.Number W.O.Number Contract Number Work Ordered by
Purchase Order not required Teresa Lewis
Job Description Site Name SDG Number Invoice Contact
See below Lisa Kempa
Job No. Job Description Receipt Date Quantity Unit Price Amount
N9ethodfrest Description
J25285-1 Carmel 06/05/2013
200.8-Total Recoverable Cd,Cr,Cu,Ni,Ph,Zn 1.00 78.00 78.00
Environmental Management Fee 1.00 3.90 3.90
Project Number Client Number Project Nlanager Subtotal $81.90
24009460 1406871 Josh McKinney
Latest Sample Receipt Date Latest Report Date Phone Number Total $81.90
06/05/2013 06/11/2013 (330)497-9396
For proper credit,please include invoice number on all remittance
TestAmerica Canton-4101 Shuffel Street NW,North Canton,OH 44720
This invoice falls under TestAmerica Laboratories Inc Standard T&C's of Net 30 Days unless superseded by another valid contract vehicle to Page I of I
place at the time these services were rendered.
VOUCHER # 135766 WARRANT # ALLOWED
I
00353237 IN SUM OF $
TESTAMERICA INC
PO BOX 99742
Chicago, IL 60690
1
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
24143926 01-7352-05 $81.90
I
Voucher Total $81.90
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
00353237
TESTAMERICA INC Purchase Order No.
PO BOX 99742 Terms
Chicago, IL 60690 Due Date 6/12/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/2013 24143926 $81.90
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 fficer