HomeMy WebLinkAbout232070 04/30/14 +ui.C�gyf
CITY OF CARMEL, INDIANA VENDOR: 368117
ONE CIVIC SQUARE WORKSAFE USA CHECK AMOUNT: $*****1,085.48*
ra CARMEL, INDIANA 46032 326 HOPPLE HILLS DR. CHECK NUMBER: 232070
', tory SPRINGFIELD IL 62707 CHECK DATE: 04/30/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4467099 31870 WS2201 1,085.48 DUMP LOK
5
I E-mail Web Site Invoice
hking a worksafe... www.dump-lok.com
WorkSafe USA, Inc. Phone# Fax# Date Invoice#
326 Hopple Hills Dr WS2201
Springfield, IL 62707 217-553-0963 217-487-7212 4/16/2014
Bill To Ship To
City of Carmel-Street Dept. City of Carmel-Street Dept.
Jeff Stewart Jeff Stewart
3400 West 131 st Street 3400 West 131 st Street
Carmel, IN 46074 Carmel, IN 46074
P.O. Number Terms Rep Ship Via F.O.B.
31870 Due on receipt 4/16/2014 FedEx Ground Ship Point
Quantity Item Code Description Price Each Amount
1 DL 105 FT Dump-Lok dump truck bed safety device system 1,000.00 1,000.00
WSM003119
shipping shipping 60.48 60.48T
handling handling charge 25.00 25.00T
Out-o(=state sale,exempt from sales tax 0.00% 0.00
I
Thank you for your business.
Total $1,085.48
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))
04/16/14 WS2201 $1,085.48
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
WorkSafe USA, Inc.
IN SUM OF $
326 Hopple Hills Dr.
Springfield, IL 62707
$1,085.48
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE I AMOUNT Board Members
31870 I WS2201 12201-670.99 $1,085.48 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
r ,.�� 5, 2014
StreeSPe6t`-'&Hft'iWioner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund