181999 02/03/2010 s CITY OF CARMEL, INDIANA VENDOR: 00350856 Page 1 of 1
1 t' ONE CIVIC SQUARE LEHIGH SAFETY SHOES CHECK AMOUNT: $422.84
�o CARMEL, INDIANA 46032 PO BOX 371958
oN Lo PITTSBURG PA 15250 -7958 CHECK NUMBER: 181999
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 S11623 451395 422.84 BOOTS
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Lehigh Outfitters, LLC Cust.No. Report Invoice Date Invoice#
39 East Canal Street
Nelsonville, Ohio 45764 I 085893 00000 00617 01/20/10 451395
I
Sold To: Ship To:
i, CARMEL WATER& WASTEWTR CARMEL WATER& WASTEWTR
TREATMENT PLANT TREATMENT PLANT
760 3RD AVE. SW 9609 HAZEL DELL PKWY
CARMEL IN 46032 INDIANAPOLIS, IN 46280
Customer's Order Number Mobile -Unit Order Date Terms
447660 LEHIGH #5378 INDIANAPOLIS (CTR
01/20/10 30 DAYS NET
S :es— 'Einp:o ��n'Epl yec
Uliti ivitt tidj `Sale`s Sen Lm e Casli Company Employe Pay
Sli. Id Name Dept Style W 5iz Qty Price" Am Amt Tax Fee Freight Total Recv Subsidy Bal DuelDed# I^
009902 randy massingill 5040 M 10 2 75.00 150 -00 150.00 150.00
009903 AARON HOOVER R5007 M 12 1 134.99 134.99 134.99 134.99
009904 ICAH BECK XPS553 M 9.5 1 54.00 54.00 114.00 114.00
009904 MICAH BECK XSC56I M 9.5 1 60.00 60.00
009905 MICAH BECK LS72IGY M 0 3 7.95 23.85 23.85 23.85
1
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L____
Total Qty Total Merchandise Adjustment Sales Tax Sets Fee Freight Cash Ric Company Subsidy Amount Due
8 422.84 422.84 422.841_
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'VOUCHER 0972Q2 WARRANT ALLOWED
350856 IN SUM OF
LEHIGH SAFETY SHOES CO.
P.O. Box 371958
Pittsburgh, PA 15250
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
451395 01- 7200 -01 $422.84
\\a
Voucher Total $422.84
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts ityForm 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
350856
LEHIGH SAFETY SHOES CO. Purchase Order No.
P.O. Box 371958 Terms
Pittsburgh, PA 15250 Due Date 1/26/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
1/26/2010 451395 $422.84
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 c
Date Officer