227692 1/8/2014 �qF CITY OF CARMEL, INDIANA VENDOR: 365868 Page 1 of 1
ONE CIVIC SQUARE CRYOTECH DEICING TECHNOLOGY
CARMEL, INDIANA 46032 CHECK AMOUNT: $12,030.00
' DEPT LA 23065
PASADENA CA 91185-3065
CHECK NUMBER: 227692
CHECK DATE: 1/8/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4236500 IN29882 30 . 00 SALT & CALCIUM
2201 R4236500 31265 IN29882 12, 000 . 00 POTASSIUM ACETATE
INVOICE Date Page
12/02/13 1
Invoice Number
General Atomics International Services Corporation IN29882
dba Cryotech Deicing Technology
6103 Orthoway,Fort Madison,IA 52627-9415
(319)372-6012 (800)346-7237
PLEASE CALL 800-346-7237 FOR QUESTIONS REGARDING THIS INVOICE. THANK YOU FOR YOUR ORDER!
Sold To: Carmel Street Department ShipTo:
Carmel Street Department
3400 W 131st Street 1 Civic Square
Carmel,IN 46074 Carmel,IN 46032
Bill To Code: CARMELS Ship To Code: CARXX
Order No. Order Date GSA Contract# Reference PO Number Ship Via FOB Terms Due Date
BL48045 11/26/13 31265 LIQTAG Origin NET30 01/01/14
cfty. Ship
Shp. From Item Number Description Unit Price UOM Extended Price
2,406.0( 01 2100-60 Cryotech CF7 Liquid Coml Deicer/Bulk 5.0000 GAL 12,030.000
Shipped bulk CF7 from Fort Madison,IA on 11/29/13 via Tague
Trucking
Payment Term NET30:Net 30 Days
Remit to: Cryotech Deicing Technology Tax summary: Subtotal 12,030.00
Dept LA 23065 IN Tax Exempt Total sales tax 0.00
Pasadena,CA 91185-3065 Total amount 12,030.00
Federal Tax ID#: 33-0270225
Less Payment 0.00
Amount Due 12,030.00
A late payment charge will be assessed on past due balances at the rate of 18%per year or at the maximum rate permitted by law in the state of residence,whichever is less
VOUCHER NO. WARRANT NO.
ALLOWED 20
Cryotech Deicing Technology
IN SUM OF $
Dept LA 23065
Pasadena, CA 91185-3065
$12,030.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Member:
31265 IN29882 42-365.00 $12,000.00 1 hereby certify that the attached invoice(s), or
2201 IN29882 42-365.00 $30.00 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
/ I , �/Sund y Jan 05, 2014
Street Commissio
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))
12/02/13 I N29882 $12,000.00
12/02/13 I N29882 $30.00
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
20
Clerk-Treasurer