247969 07/28/15 q CITY OF CARMEL, INDIANA VENDOR: 226500
® '1 ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: S""""161.16'
r. 4 CARMEL, INDIANA 46032 PO sox 4250 CHECK NUMBER: 247969
UTICA NY 13504 CHECK DATE: 07/28/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 901516019 161.16 OTHER EXPENSES
RTHERN Remember.. We Always Offer 0
• Our Lowest Price When You Order. PLEASE REMIT TO:
Pc) Box 4250 0 Utica, NY 13504-4250 100%Satisfaction Guaranteed! NORTHERN SAFETY CO.,INC.
Phone: 800.631.1246 0 Fax: 800.635.1591 P.O. Box 4250
northernsafety.com Utica, NY 13504-4250
SHIP TO(IF OTHER THAN"SOLD TO")
J YOURCUSTOMER ID City Of Carmel
R16F6�4•!YO` O' MERI 16,PUR INVOICE
346023 4915 E 106th St
CARMEL IN 46033-3800
SOLD F—Carmel Utilities USA
TO:
3450 W 131 st St
CARMEL IN 46074-8267 L
USA
Andy 07/15/2015
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 08/14/2015
INVOICE NO./ORDER NO.,
901516019/100856641 07/15/2015 FEDEX GROUND 07/15/2015 IF PAID BY 08/04/2015 PAY $ 158.28
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE �EXTENDED AMOUNT
2 2 18699 10 PR SKECHERS MENS COMPOSITE TOE SNEAKR SZ 10 71.95 143.90
ISD
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 $ 17.26 $ 161.16
UNPAID BALANCE.
Payments-must be-payable in-US dollars only
2%discount does not apply to credit card payments Thank You for Your Order!
FEDERAL ID#16-1214814
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
226500
NORTHERN SAFETY CO, INC Purchase Order No.
PO BOX 4250 Terms
UTICA, NY 13504 Due Date 7/21/2015
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/21/2015 901516019 $161.16
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
VOUCHER # 152561 WARRANT # ALLOWED
226500 IN SUM OF $
NORTHERN SAFETY CO, INC
PO BOX 4250
UTICA, NY 13504
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
901516019 01-6200-03 $161.16
Voucher Total $161.16
Cost distribution ledger classification if
claim paid under vehicle highway fund