224132 09/10/2013 CITY OF CARMEL, INDIANA VENDOR: 00351427 Page 1 of 1
0 ONE CIVIC SQUARE STATE INDUSTRIAL PRODUCTS
CARMEL, INDIANA 46032 PO BOX 74189 CHECK AMOUNT: $347.33
CLEVELAND OH 44194
CHECK NUMBER: 224132
CHECK DATE: 911 012 01 3
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4238900 4855300 347 . 33 OTHER MAINT SUPPLIES
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Invoice PAGE: 1
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6915 Landerbrook Drive,Suite 300
all@Mayfield Heights,Ohio 44124 1 96412186 08/26/2013 09/10/2013
Chemical www.statechomical.com If you would like to receive your invoice via tax, please
Chemical Phone:440-565-5555 •866-747-2229 contact our Customer Service Department.
Slate Chemical Solutions is a Division of Slate Indusirial Products Your Fax number on file is: 317-571-2409
Our Customer Service Phone number is: 1-800-782-2436
30467119-29203-1YA5D-1429130014-0384-6x9 1/1 SHIP TO:
Customer No. : 21236 CITY OF CARMEL
CITY OF CARMEL CITY HALL
CITY HALL 1 CIVIC SQUARE FAA
1 CIVIC SQUARE CARMEL, IN 46032 ::a 9001
014001
CARMEL IN 46032 OMI-SAI Global
Customer P.O.: Jeff Barnes Sales Order: 4855300 Delivery: 801761979:1
Your Account Manager: 90142458 SARAH LUTH Taxable: N I
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0 2 2 CS 122626 SCRUB ENDER QT12 156.000 312.00
PHA-NK YOU FOR YOUR CRDER!
D Q
0 9 2013 i
By
1. IMPORTANT: Please return remittance portion
of invoice with your payment. To assure proper ............
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credit to your account, ALWAYS include your ales Shipping8Phicessing, Sales
customer number, invoice number, and amount
paid with your remittance. 1 312.00 35.33 0.00 347.33
2. All shipments FOB nearest warehouse.
3. Claims for shortage or damaged goods must be We hereby certify that these goods were produced iced h
made within 5 days after receipt of goods. all applicable requirements of Section 6, 7 and 12 of the Fair Labor
4. No returns without written authorization. Standards Act as amended, and of regulations and orders of the United
5. If you have any questions regarding this States Department of Labor issued under Section 14 thereof.
invoice please contact us at 1-800-782-2436.
PAY NO MONEY TO AGENTS FOR CHEMICAL EMERGENCY SPILL,
LEAK, FIRE, EXPOSURE OR ACCIDENT
FED. TAX I.D. NO. All tax exempt customers CALL CHEMTREC -- DAY OR NIGHT
34-0552740 must submit tax exempt (800) 424-9300
certificate with payment.
VOUCHER NO. WARRANT NO.
ALLOWED 20
State Industrial Products
IN SUM OF $
P.O. Box 74189
Cleveland, OH 44194-0268
$347.33
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
T
1205 I 4855300 I 42-389.00 I $347.33 1 hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Mond y, September 09, 2013
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
08/26/13 4855300 $347.33
1 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
20
Clerk-Treasurer