183936 03/29/2010 „yF CITY OF CARMEL, INDIANA VENDOR: 276575 Page 1 of 1
ONE CIVIC SQUARE SAFETY SOLUTIONS, INC CHECK AMOUNT: $143.00
CARMEL, INDIANA 46032 PO BOX 8100
i o io DUBLIN OH 46016 -2100 CHECK NUMBER: 183936
CHECK DATE: 3/2912010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1662656 143.00 OTHER EXPENSES
i'
'1
p t^rT j�� �g�� 6161 Shamrock Ct P.O. Box 8100
J R a Dublip, off 43016 -2100 r 01662656
I N C O R P O A T E D 800.232.7463 (tax)614.799.9901 �i1VOfCe
�1
Regional offices 8 Distribution Cente `t 7 r Page 1
Birmingham, AL Mobile, AL Columbus, OH Toledo. OH
866.241 9399 888 -871 7463 800.232.7463 419.380.9900
r1
Date 3 03/04/2010
Pittsburgh, PA Syracuse, NY Auburn, IN a t�
800.562 0555 600.836.7463 260.927.1956 r
Due�Date 03/10/2010
t
Sold To: 129700 Ship To: 1
City Of Carmel City of Carmel
Water Distribution Sewer Department
3450 W 131st ST 760 3rd Ave. SW, Suite 110
Westfield, IN 46074 Carmel, IN 46032
ustomer PONumber Release No Salesperson Whse Shlp� Date Docultient
M
r+ t �e
qj_ e i
�__DAI��RYL"
f
arms Taz Code
Freight Shtp Ula
Net 15 IN15 Prepaid Fedex Ground Intl Economy
�ItemsNumber Descrlptlon Or'dered� SMOP, Backorder- F 1 Price� Per Extension
iff l_ 0100000669680130 1 0 125.00 PR 125.00
6696 ROCKY SZ. 13W
DARRYL
Shipping warehouse: 90
0151103 2 2 0 PR 9.00 PR 18.00
110 SOLETECH INSOLE
MENS: 11 -12
Shipping warehouse: 90
s
Remit To: Safety Solutions InC. Merchandise S H'' Taz Payments r Total Due
PO Box 8100
Dublin, OH 43016 -2100 143.00 0.00 0.00 143.00
VOUCHER 105107 WARRANT ALLOWED
X276575 IN SUM OF
SAFETY SOLUTIONS, INC
PO BOX 8100
DUBLIN, OH 46016 -2100
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1662656 01- 7200 -01 $143.00
f
r
V
Voucher Total $143.00
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
276575
SAFETY SOLUTIONS, INC Purchase Order No.
PO BOX 8100 Terms
DUBLIN, OH 46016 -2100 Due Date 3/22/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
3/22/2010 1662656 $143.00
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
..i j lam`.=
Date Officer Officer