246463 06/1 7/1 5 �/ t� CITY OF CARMEL, INDIANA VENDOR: 226500
J ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $*****1,168.50*
:9� �_�. CARMEL, INDIANA 46032 PO BOX 4250 CHECK NUMBER: 246463
M��roN"�°' UTICA NY 13504 CHECK DATE: 06/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4356003 901440933 1,168.50 SAFETY ACCESSORIES
NORTHERN Remember...We Always Offer
• Our Lowest Price When You Order. PLEASE REMIT TO.
PO Box 4250 . Utica, NY 13504-4250 100%Satisfaction Guaranteed! NORTHERN SAFETY CO.,INC.
Phone: 800.631.1246 • Fax: 800.635.1591 P.O. Box 4250
northernsafety.com Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
YOUR CUSTOMER ID F Carmel Fire Department
PLEASE REFER TO YOUR CUSTOMER . OUR INVOICE AND
ORDER NO. ' "' 416610 Gary
2 Civic Sq
SOLDCARMEL IN 46032-2584
TO: Carmel Fire Department USA
2 Civic Sq
CARMEL IN 46032-2584
USA
Gary 05/26/2015
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 06/25/2015
INVOICE NO`/ORDER NO.
901440933 1100811879 05/26/2015 FEDEX GROUND 05/26/2015 IF PAID BY 06/15/2015 PAY $ 1145.13
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
50 50 1665 M PR GRAIN LEA DRIVERS GLV KEYSTONE THUMB M 7.79 389.50
50 50 1665 L PR GRAIN LEA DRIVERS GLV KEYSTONE THUMB L 7.79 389.50
50 50 1665 XL PR GRAIN LEA DRIVERS GLV KEYSTONE THUMB XL 7.79 389.50
1 1 10195 F EA VISUVIO SILVER MIRROR E-BLAST EYEWEAR 0.00 0.00
1 1 BC152 EA 2015 CATALOG KIT 0.00 0.00
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 11/2%PER SALES TAX SHIPPING&HANDLING
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE _ $ 0.00 $ 0.00 $ 1168.50
UNPAID BALANCE.
_-Payments must-be novable in US dollars only _
VOUCHER NO. WARRANT NO.
ALLOWED 20
Northern Safety
IN SUM OF$
P.O. Box 4250
Utica, NY 13504
$1,168.50
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 901440933 43-560.03 $1,168.50 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
JUN 9 5 2015
Al
Fire Chief
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))
901440933 $1,168.50
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