259697 06/14/16 0a/ CITY OF CARMEL, INDIANA VENDOR: 363840
j; ® ONE CIVIC SQUARE STATE SAFETY & COMPLIANCE LLC CHECK AMOUNT: S.......108.02"
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CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A CHECK NUMBER: 259697
9M!'roN.i�` INDIANAPOLIS IN 46203 CHECK DATE: 06/14/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 10383298 108.02 OTHER EXPENSES
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
363840
STATE SAFETY& COMPLIANCE LLC Purchase Order No.
5338 VICTORY DRIVE STE A Terms
INDIANAPOLIS, IN 46203 Due Date 6/3/2016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/3/2016 10383298 $108.02
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
Date Officer
State Safety & Compliance, LLC. INVOICE
Branch: 701 Indianapolis
5358 Victory Dr INVOICE
Indianapolis,IN 46203 10383298
Invoice Date Page
5/26/2016 08:38:01 1 of 1
317-423-7724 ORDER NUMBER
Bill To: 3960116
Carmel Waste Water Treatment "DIRECT SHIPMENT`*
Attn: Paul Arnone Ship To:
9609 Hazel Dell Parkway Carmel Waste Water Treatment(S 16127)
Indianapolis, IN 46280 Carmel W.W.T. Attn: Duane Jarvis
9609 Hazel Dell Parkway
Indianapolis, In 46280
Customer ID: 109095
PO Number Terms Description Net Due Date Disc Due Date Discount Amount
516127 0.5% 10 net 30 6/25/2016 6/5/2016 0.41
Order Date Pick Ticket No Primary Salesrep Name Taker
5/24/2016 08:07:47 6389519 Gary Smith PGENDRON
Quantities Pricier
S
Item ID UOM Unit Extended
Ordered Shi ed Reu�ainin UOM a Item Description Price Price
pP g Unit Size O Unit Size
Carrier: UPS Ground-PPA Tracking#:
10.0000 10.0000 0.0000 EA COR038002055 EA 8.1500 81.50
1.0 RIBS 48" FIBERGLASS FOR ROLL UP SIGNS 1.0000
Fiberglass Roll-Up Sign Ribs(A-Frame,Tri-Pod,
&T-Stand)
Total Lines:I SUB-TOTAL: 81.50
Total Freight In:0.00 Total Freight Out:26.52 TOTAL FREIGHT. 26.52
- -- -- ------ - -- -- -- - -- -- -------- - - - -- TAX: 0.00
AMOUNT DUE: 108.02
U.S. Dollars
ORIGINAL
� PACKING LIST
AIWM AIJ
q)
e v a min= WIMP-1Invoice No.: 5056203
Safety Products Date: 5/25/16
10706 W.Grand Avenue•Franklin Park,IL 60131
847.455.2800•Fax:847.451.7247
www.cortinaco.com Ship To: 66655
CARMEL WASTE WATER TREATMENT
ATTN: DUANE JARVIS (S16127)
9609 HAZEL DELL PARKWAY
INDIANAPOLIS, IN 46280
---------------------------------------------------------------------------------------------------------------------------
Customer P.O. Pro Number Shipped Via Ship Date
1686851 170743 UPS GROUND 5/25/16
Tracking# 1ZEF9156O347643O38
---------------------------------------------------------------------------------=-----------------------------------------
Due Original Qty. Balance Customer PCs./ Net Tare Total
Date Ordered Shipped Due Part # Part # Crtn. Ctns Lbs Wgt Wgt
---------------------------------------------------------------------------------------------------------------------------
5/28/16 10 10 0 03-800-2055 10 1 .00 .00 .00
RIBSETS FOR 48" ROLLUP SIGNS
Against P.O.# 1686851
KC P/N 17267
JS P/N 3006685
UPS FREIGHT/FREIGHT & HANDLING - 5055
CAROLYN