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