189354 08/31/2010 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
`j ONE CIVIC SQUARE HALSEN PRODUCTS CHECK AMOUNT: $174.89
CARMEL, INDIANA 46032 PO BOX 877
.o BELMONTMS 38827 CHECK NUMBER: 189354
CHECK DATE: 8/31/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0107707 -IN 174.89 UNIFORMS
HALSEN PRODUCTS COMPANY
IN VOIC E PAGE: 1
P.O. BOX 877
BELMONT, MS 38827
NATIONWIDE 1 800 344 6696 INVOICE NUMBER: 010 7 7 0 7 I N
FAX 1 -8839
INVOICE DATE:
8/11/2010
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ACCOUNTS PAYABLE DEPT BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
CUSTOMER P:O, SHIP:VIA, t,', :F.O:B, TER M1/IS..
BONNIE �t,���, UPS Net 30
ITEM NO. UNIT. .:pRDERED SHIPPEb'. BACK ORDER PRICE AMOUNT.
EACH 12 1 2 0 4.400 52.80
ZONE IT MATTE BLK /ICE 0 G MIRR
I EACH 12 12 0 4.600 55.20
ZONE II'SILVER /I E BLUE MIRROR
EACH 12 12 0 4.600 55.20
ZONE II SILVER /I E ORG 4IRROR
P3e•t Invoice: 163 -20
Less Discount': 0.00
THANK YOU YOUR Freight: 11.69
Sales -Tax: 0.00
Invoice Total: 174.89
Less Deposit: 0.00
8
INVOICE BALANCE
VOUCHER NO. WAR N
ALLOWED 20
Halsen Products
IN SUM OF
P. O. Box 877
Be�mont, MS 38827
$174.89
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT #!TITLE I AMOUNT
Board Member:
21419 0107707 -IN 43- 560.01 $174.89 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thur August 26, 2010
)ol l
Street Commissione�'r�
Street CTtl
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/11/10 0107707 -IN $174.89
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
20
Clerk- Treasurer