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HomeMy WebLinkAbout187040 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 363840 Page 1 of 1 G' ONE CIVIC SQUARE STATE SAFETY COMPLIANCE LLC CARMEL, INDIANA 46032 5338 VICTORY DRIVE STE A CHECK AMOUNT: $86.74 INDIANAPOLIS IN 46203 CHECK NUMBER: 187040 CHECK DATE: 6/23/2010 DEPARTMENT ACCOUNT P O NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 9717222 86.74 OTHER EXPENSES INVOICE State Safety Compliance, LLC. INVOICE Branch: 701 Indianapolis 9717222 5338 Victory Dr Invoice Date Page Suite A 6/8/2010 15:42:23 1 of I Indianapolis, IN 46203 ORDER NUMBER 3493134 317 423 -7724 Bill To: Ship To: City of Carmel Utilities City of Carmel Utilities Wastewater Carmel W.W.T.P (Jeff Cooper) 760 Third Ave. SW, Suite 110 9609 Hazel Dell Parkway Carmel, IN 46032 Indianapolis, In 46280 Customer ID: 109095 PO Number Terms Description Net Due Date Disc Due Date Discount Amount JEFF COOPER 3/31/10 0.5 10 net 30 07/08/10 06/18/10 0.39 Order Date Pick Ticket No Primary Salesrep Name Taker 3/31/2010 09:49:30 5721707 Gary Collins JCHANEY Quantities Pricing Item ID UOM Unit Extended Ordered Stripped Remaining UOM 4 Item Description Unit Size Price Price Unit Sipe O Delivery Instructions: UPS GROUND PREPAY ADD Carrier: UPS Ground PPA Tracking IZ203YOA0352293798 6.0000 6.0000 0.0000 EA KHG5001 EA 7.5500 45.30 1.0 HEADGEAR FOR FACESHIELD 1 6.0000 6.0000 0.0000 EA NRCHG5002 EA 2.8900 17.34 1.0 CHIN PROTECTOR FIT HEADGEAR/FACESHIELD l TO BE USED W/ KHG5001 OR PHG5000 10.0000 10.0000 0.0000 EA NRA8153 /40 EA 1.6100 16.10 1.0 FACESHIELtD CLEAR SY15 !/2 rDIR CUT V!SOR MIN QTY ORDER IS 10 EACH ..HOLES FOR CHIN PROTECTOR CHG5002 Total Lines: 3 SUB- TOTAL: 78.74 Total Freight In: 0.00 Total Freight Otrl: 8.00 TOTAL FREIGHT: 8.00 TAX: 0.00 AMOUNT DUE: 86.74 ORIGINAL 1 /OUCHER 105645 WARRANT ALLOWED 363840 IN SUM OF STATE SAFETY COMPLIANCE LLC 5338 VICTORY DRIVE STE A INDIANAPOLIS, IN 46203 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 9717222 01- 7202 -06 $86.74 Voucher Total $86.74 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 363840 STATE SAFETY COMPLIANCE LLC Purchase Order No, 5338 VICTORY DRIVE STE A Terms INDIANAPOLIS, IN 46203 Due Date 6/14/2010 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/14/2010 9717222 $86.74 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 6// 7/r,, C,-..,--a- %,1 Date Officer