183890 03/29/2010 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $80.00
CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 183890
CHECK DATE: 3/29/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 26053410103 80.00 OTHER EXPENSES
jN QRTHERN Remember.. We Always Offer 1
,1rj-�=?MrT M-M Our Lowest Price When You Order. PLEASE REFIT TO:
PO Box 4250 Utica, NY 13504-4250 100% Satisfaction Guaranteed! NORTHERN SAFETY CO., INC.
Phone: 800. 631 .12A6 Fax: 800. 635.1691 P.O. Box 4250
northernsafety.com Utica, NY 13504 -4250
SHIP TO (IF OTHER THAN "SOLD TO
YOUR CUSTOMER ID CITY OF CARMEL
PLEASE REFER TO YOUR YOUR CUSTOMER ID, OURINV "ICqA�D 6RDERN 0002411866 5484 EAST 126TH STREET
CARMEL, IN 46033
SOLD
T0: CITY OF CARMEL
ATTN UTILITIES DEPT
3450 W 131ST ST
WESTFIELD, IN 46074
KRIS 01/13/10
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED
INVOICE NOJORDER N0. PAYMENT DUE BY 02/24/10
P260534101039 01125110 UPS GROUND 01/25/10 IF PAID BY 02/14/10 PAY $78.48
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
1 1 145 -26328 105 01 PR SKECHERS MENS STEEL TOE SPORT SNEAKERSZ10576710 75.95 75.95
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1' /2% PER SALES TAX SHIPPING HANDLING p n
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 10% TO BE APPLIED TO THE 4.05 80
UNPAID BALANCE.
Payments must be payable in US dollars -only
2% discount does not apply to credit card payments Thank You for Your Order!
VOUCHER 101168 WARRANT ALLOWED
y
226500 IN SUM OF
NORTHERN SAFETY CO, INC
PCB? BOX 4250•
UTICA, NY 13504 0
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
26053410103 01- 6200 -03 $80.00
Voucher Total $80.00
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 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 3/22/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/22/2010 2605341010: $80.00
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 Officer