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CITY OF CARMEL, INDIANA VENDOR: 363840
i i ONE CIVIC SQUARE STATE SAFETY &COMPLIANCE LLC CHECK AMOUNT: $*****3,252.31*
:• ,� CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A CHECK NUMBER: 236537
+,,..,._. INDIANAPOLIS IN 46203 CHECK DATE: 08/27/14
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DEPARTMENT ACCOUNT. PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 10173479 3,252.31 OTHER EXPENSES
INVOICE
State Safety & Compliance, LLC.
INVOICE
Branch: 701 Indianapolis 10173479
5358 Victory Dr Invoice Date Page
Indianapolis,IN 46203 8/7/2014 16:34:44 1 of 2
ORDER NUMBER
3805961
317-423-7724
Bill To: Ship To: **DIRECT SHIPMENT"
Carmel Waste Water Treatment Carmel Utilites
Attn: Paul Arnone Attn JASON STEWART(P0514196)
9609 Hazel Dell Parkway 9609 Hazel Dell Parkway
Indianapolis,IN 46280 Indianapolis,In 46280
- Customer ID: 109095 -
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
514196 0.5% 10 net 30 09/06/14 08/17/14 15.70
Order Date Pick Ticket No Primary Salesrep Name Taker
8/5/2014 14:22:12 6179425 Gary Smith JCHANEY
Quantities Pricing
Item ID UOM Unit Extended
Ordered Shipped Remaining UOM a Item Description Unit Size Price Price
Unit Size C
Delivery Instructions: UPS GROUND PREPAY&ADD
Carrier: UPS Ground-freight collect Tracking#:
2.0000 2.0000 0.0000 EA 07-800-4033 EA 132.0000 264.00
1.0 SIGN 48" ROLL UP REFLTV"RT LN CLSD AHD" 1
RIGHT LANE CLOSED AHEAD; SUPER
BRIGHT REFLECTIVE MATERIAL
2.0000 2.0000 0.0000 EA 07-800-4087 EA 33.3333 66.67
1.0 SIGN 48"OVERLAY"LEFT" 1
2.0000 2.0000 0.0000 EA 07-800-4043 EA 132.0000 264.00
1.0 SIGN 48" MERGE RIGHT SYMBOL ROLL UP RFLT 1
SUPER BRIGHT REFLECTIVE
2.0000 2.0000 0.0000 EA 07-800-4045 EA 132.0000 264.00
1.0 SIGN 48" MERGE LEFT SYMBOL ROLL UP RFLT 1
SUPER BRIGHT REFLECTIVE
2.0000 2.0000 0.0000 EA 07-800-4046 EA 132.0000 264.00
1.0 SIGN 48"UTILITY WORK AHEAD RFLTV 1
SUPER BRIGHT REFLECTIVE
2.0000 2.0000 0.0000 EA 07-800-4025 EA 132.0000 264.00
1.0 SIGN 48"FLAGGER SYMBOL REFLECTIVE 1
_. SUPER BRIGHT
ORIGINAL
INVOICE
State Safety & Compliance, LLC. INVOICE
Branch: 701 Indianapolis 10173479
5358 Victory Dr Invoice Date Page
8/7/2014 16:34:44 2 of 2
Indianapolis,IN 46203
ORDER NUMBER
3805961
317-423-7724
Quantities Pricing
Item ID UOM Unit Extended
UOM 4 Item Description Price Price
Ordered Shipped RemainingUnit Size C Unit Size
6.0000 6.0000 0.0000 EA 07-801-1 EA 182.0000 1,092.00
1.0 SIGN STAND FOR 36/48" 14"OFF GROUND 1
2.0000 2.0000 0.0000 EA 03-823P EA 43.0000 86.00
_1.0 SIGN24" STOPISLOW-8.1"_PLASTIC_HANDLE
HI SHEETING
2.0000 2.0000 0.0000 EA 03-300 EA 12.5000 25.00
1.0 WAND LED BATON 12"C-CELL 1
STEADY ON/SLOW FLASH/FAST FLASH
20.0000 20.0000 0.0000 EA 03-500-10 EA 14.3500 287.00
1.0 CONE 28"ORANGE W/4 AND 6" REFLECTIVE 1
2.0000 2.0000 0.0000 EA 07-800-4035 EA 132.0000 264.00
1.0 SIGN 48" ROAD CLOSED AHEAD REFLECTIVE 1
SUPER BRIGHT
Total Lines:11 SUB-TOTAL: 3,140.67
Total Freight In:0.00 Total Freight Out:111.64 TOTAL FREIGHT. 111.64
TAX. 0.00
AMOUNT DUE: 3,252.31
ORIGINAL
VOUCHER # 145399 WARRANT# ALLOWED
363840 IN SUM OF $
STATE SAFETY & COMPLIANCE LLC
5338 VICTORY DRIVE STE A
INDIANAPOLIS, IN 46203
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
10173479 01-7200-02 $3,252.31
i
,j
i
Voucher Total $3,252.31
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 bero erl itemized must show, kind of service where
P P Y
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
363840
STATE SAFETY&COMPLIANCE LLC Purchase Order No.
5338 VICTORY DRIVE STE A Terms
INDIANAPOLIS, IN 46203 Due Date 8/21/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) . Amount
8/21/2014 10173479 $3,252.31
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
Date P O er