184924 04/27/2010 CITY OF CARMEL, INDIANA VENDOR: 276575 Page 1 of 1
ONE CIVIC SQUARE SAFETY SOLUTIONS, INC
)a CARMEL, INDIANA 46032 PO Box 8100 CHECK AMOUNT: $135.00
DUBLIN OH 46016 -2100
CHECK NUMBER: 184924
CHECK DATE: 4/2712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 01683073 135.00 OTHER EXPENSES
6161 Shamrock CL• PO Box 8100
f A- 0 Dublin, off 43016-2100 E I�n�o�ce 01683073
I N C 0 F1 P 0 8 AT E D 800.232.7463 (fax)614.799.9901
Regional Offices Distribution Centers P 9
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Birmingham, AL Mobile, AL Columbus, OH Toledo, OH 1
866241 9399 888.871.7463 800.232.7463 419.380.9900 g g',�
Date 04/02/2010
Pittsburgh, PA Syracuse, NY Auburn, IN
800.562.0555 800.836.7463 260927.1956
Q4/17 201
Sold To 129700 Ship To: 129700
City Of Carmel City Of Carmel
Water Distribution Water Distribution
3450 W 131 st ST 3450 W 131st ST
Westfield, IN 46074 Westfield, IN 46074
r
Customer PO Nuriibe r `Releaseo Salesperson M� Whse 1 E Sfnp Date `Document
P5 G B T Jason Barzak v1 04/02/2010 01486 X82
a Terms:„ a Frelht hip V
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Tax Code
S is
Net 15 IN15 Prepaid Fedex Ground Intl Economy
Exte
Item Number Description r� Ordered Skipped gBackorderg, UMi E �Prlce r Pe'r�;nslon
0100000380591130 1 1 0 PR 135.00 PR 135.00
3805 WOLVERINE BOOT 13EW
Shipping warehouse: 58
Solutions, Inc. ua
Remit To: Safety Merchandise S& HF E Tax�� Payments Total Due
PO Box 8100 A Ern
Dublin, OH 43016 -2100 135.00 0.00 0.00 135.00
VOUCHER 101407 WARRANT ALLOWED
276575 IN SUM OF
SAFETY SOLUTIONS
6161 Shamrock Ct.
P.0.' Box 8100
D ublin, OH 43016
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
01683073 01- 6200 -03 $135.00
Voucher Total $135.00
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 Purchase Order No.
6161 Shamrock Ct. Terms
P.Q. Box 8100 Due Date 4/20/2010
Dublin, OH 43016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/20/2010 01683073 $130.00
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