225590 10/23/2013 CITY OF CARMEL, INDIANA VENDOR: 360941 Page 1 of 1
ONE CIVIC SQUARE UNDERWRITERS LABORATORIES INC CHECK AMOUNT: $400.00
CARMEL, INDIANA 46032 9334 PAYSPHERE CIRCLE
CHICAGO IL 60674 CHECK NUMBER: 225590
CHECK DATE: 10/23/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 205571 400 . 00 6350 . 03
Please detach and return upper portion with payment. Please reference Invoice Number with payment.
Customer Information
Underwriterst'a$o atories Inc. Invoice Date: 09/26/13
9334 Paysphere Circle
Chicago, IL 60674 Payment Terms: Net 30 Days
Acct#5800399205 Order#: 242267
ABA#071000039 Report#: 303258
Client#: 5683
P.O.#: pending
Invoice#205571 Customer Contact: Kerri Loveall
Description/Matrix/Sample Type Unit Price Qty $Disc Net
Giardia/Cryptosporidium (Filter)/GW/FS $450.00 1 $50.00 $400.00
Sample Kit, Bottles, Preservatives No Charge
Collection Instructions No Charge
State Approved Report, if req'd No Charge
Standard Outgoing Shipping No Charge
Site Description: Total Tests 1 Total($ US) $400.00
See Enclosed report for details.
A Finance Charge of 1.5%per month Thank you for selecting
may be added to past-due accounts. Underwriters Laboratories Inc.
for your analytical services.
Simplify your life. With one call,UL can pre-schedule all your bottle shipments so that your bottles arrive just in
time for monitoring. Provide your monthly,quarterly,or annual requirements to your project manager and we'll
ship out your bottles when needed for the entire year.
The charges for services rendered are being invoiced by the entity designated on Page 1,on behalf of UL LLC.
If you have any questions concerning this invoice, please do not hesitate to call us at 1-800-332-4345.
Did you know that UL certifies Drinking Water Treatment Chemicals to ANSI/NSF 60?
Page 1 of I
VOUCHER # 133038 WARRANT# ALLOWED
360941 IN SUM OF $
UNDERWRITERS LABORATORIES INC
9334 PAYSPHERE CIRCLE
CHICAGO, IL 60674
Carrel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
205571 01-6350-03 $400.00
i
Voucher Total $400.00
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
360941
UNDERWRITERS LABORATORIES INC Purchase Order No.
9334 PAYSPHERE CIRCLE Terms
CHICAGO, IL 60674 Due Date 10/14/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/14/201: 205571 $400.00
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
101 7�_ � -• �{�/k �i I
Date Officer