227148 12/11/2013 CITY OF CARMEL, INDIANA VENDOR: 367113 Page 1 of 1
ONE CIVIC SQUARE WATER SERVICES GROUP
CHECK AMOUNT: $842.00
CARMEL, INDIANA 46032 4914 FOUNDERS COURT
oN ANDERSON IN 46017 CHECK NUMBER: 227148
CHECK DATE: 12/11/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 10143 842 . 00 OTHER EXPENSES
INVOICE# 10143
� 4914 Founders Court/Anderson, Indiana 46017
Tel:(765)617-5193/Fax:(765)37 8-0562
WATER SERvicES GROUP e/
INVOICE
Sold To: Misc
Name Carmel WWTP Date 11/17/2013
Address 9609 Hazel Dell Parkway P.O.# Verbal Jeff
City Indianapolis State IN ZIP 46280 Terms: Net 30 days
Attention: Accounts Payable Site: Carmel WWTP
Qty Description Unit Price TOTAL
1 Deliver 55 gallons of Deionized Water and pump into boiler system 10/24 $ 140.00
1 Deliver 55 gallons of Propylene Gycol and pump into boiler system 10/24 $ 677.00
1 Pump pressure up in system on 11/6/13 $ 25.00
Please provide copy of tax exemption certificate with payment
Order confirmation by Jeff Cooper
Sub Total $ 842.00
Shipping $ -
Payment Tax Rate(s)
Payable To: Mike Heirbrandt,Agent for WSG TOTAL $ 842.00
4914 Founders Court
Anderson, Indiana 46017 Office Use Only
(765)617-5193
SS#305-86-2286
WSG`4914 Founders Ct 'Anderson, Indiana 46017
VOUCHER # 136981 WARRANT # ALLOWED
367113 IN SUM OF $
WATER SERVICES GROUP
4914 FOUNDERS COURT i
ANDERSON, IN 46017 '{
I�
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
1
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
10143 01-7202-06 $842.00
I
Voucher Total $842.00
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
367113
WATER SERVICES GROUP Purchase Order No.
4914 FOUNDERS COURT Terms
ANDERSON, IN 46017 Due Date 12/5/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/5/2013 10143 $842.00
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
Date Officer