189788 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 354533 Page 1 of 1
0 ONE CIVIC SQUARE GALETON CHECK AMOUNT: $589.20
CARMEL, INDIANA 46032 PO Box 336
MANSFIELD MA 02048 -1816 CHECK NUMBER: 189788
CHECK DATE: 9/14/2010
DEPARTMEN ACCOUNT PO NUMBER INVOICE NUMBER AMO DESCRIPTION
651 5023990 922300 -00 589.20 OTHER EXPENSES
100 Foxborough Boulevard
Foxborough, MA 02035
Ordered by
CUSTOMER NUMBER INVOICE NUMBER INVOICE DATE F CARMEL WASTEWATER UTILITY
760 THIRD AVE SW
CARMEL, IN 46032
703614 922300 -00 08/26/10
L
Bill To Ship To
CARMEL WASTEWATER UTILITY —1 F CARMEL WASTE WATER PLANT
760 THIRD AVE SW 9609 HAZEL DELL PKWY
CARMEL, IN 46032 INDIANAPOLIS, IN 46280
L I L
Invoice Processing
TERMS CUSTOMER ORDER DATE SHIPPED VIA DATE SHIPPED PAGE
PURCHASE ORDER NUMBER
Met '10 days —.U-2-252 08 TTPSGRND MM 8/ 26/1C 1
LINE ITEMIDESCRIPTION QUANTITY QUANTITY QUANTITY
ORDERED SHIPPED BACKORDERED UNIT PRICE TOTAL
DIVERSION CONTRARY TO U S. LAW IE PROHIBI ED
7942 -11 E 6 0 49.95 299.70
STEEL TOE HIP BOOTS
SZ 11 1 PAIR /PKG
7942 -10 4 0 4 49.95 0.00
STEEL TOE HIP BOOTS
SZ 10 1 PAIR /PKG
7941 -13 E 6 0 28.95 173.70
5- BUCKLE RUBBER OVERSHOE
SZ 13 1 PAIR /PKG
7941 -14 3 0 28.95 86.85
5- BUCKLE RUBBER OVERSHOE
SZ 14 1 PAIR /PKG
7941 -11 0 28.95 28.95
5- BUCKLE RUBBER OVERSHO
SZ 11 1 PAIR /PKG
r
SUB TO AL; 589.20
TOTAL,..- E'' Dollars 589.20
REMIT IN US Dollars r
Galeton
PO Box 336
Mansfield, MA 02048 -181
(800)221 -0570
Thank you for your busi ess with Galeton.
"JOUCHER, 106161 WARRANT ALLOWED
4354533 IN SUM OF
GALETON SAFETY PRODUCTS
PO BOX 336
MANSFIELD, MA 02048
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
92230000 01- 7202 -06 5589.20
Voucher Total $589.20
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
354533
GALETON SAFETY PRODUCTS Purchase Order No.
PO BOX 336 Terms
MANSFIELD, MA 02048 Due Date 9/8/2010
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/8/2010 92230000 $589.20
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 ffice