190838 10/13/2010 CITY OF CARMEL, INDIANA VENDOR: 179310 Page 1 of 1
ONE CIVIC SQUARE LAB SAFETY SUPPLY INC CHECK AMOUNT: $241.99
CARMEL, INDIANA 46032 PO BOX 5004
JANESVILLE VJI 53547 -5004 CHECK NUMBER: 190838
CHECK DATE: 10/13/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1016133558 241.99 OTHER EXPENSES
Order 13v Phone: 1- 8(1(1 -3s6 -0783 1 -116 Salety Supply
Order Online: ww\v.LSS.rom Fl l r 39- 1726218
401 S. Wright Rd.
Order 13y Fac 1-800-9 43-99 1p Zanesville NVI USA. 53347 -1368
Cpl
LAB SAFETY SUPPLYA
PO Bos1368
Janesville. W1 USA 53547 -1368
002583 PAGE 1 OF 1
8 CITY OF CARMEL S CITY OF CARMEL
ACCOUNTS PAYABLE H ATTN: BILL KELLAM
L 760 3RD AVE SW P 901 N RANGE LINE RD
T CARMEL IN 46032 -2072 T HOUSEHOLD HAZ WASTE
0 o CARMEL IN 46032 -1361
Order No. P.O. No. Sold To No. Invoice No. Invoice Date Due Date
SC07272256 KELLAM092110 5208827 1 1016133558 09/21/2010 10/21/2010
Buyer Carrier Freight Terms Ship Date Payment Terms
,BILL UPSGND LOCKED 09/21/2010 Net 30
QTY. QTY. UNIT
LINE PRODUCT NO. DESCRIPTION B. 0. SHIP U.O.M. AMOUNT AMOUNT
1 135753L GLV EXAM POWERGRIP PWDR LATE 0 20 EX 11.00 220.00
SUBTOTAL: 220.00
Thank you for your order. FREIGHT: 21.99
TAXES: 0.00
PN9.352574124 i
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 10/21/2010 241.99 USD
These items are sold for domestic consumption in the United States. If exported, purchaser
assumes full responsibility for compliance with US export controls.
ORIGINAL
After 90 days from invoice date, GHC Specialty Brands, LLC will not be responsible to show proof of delivery.
TITLE TO ALL MERCHANDISE SHIPPED PASSES TO THE PURCHASER UPON DELIVERY TO THE COMMON CARRIER.
NO CLAIMS, DEDUCTIONS OR RETURNS ACCEPTED WITHOUT OUR WRITTEN CONSENT. ALL CLAIMS MUST BE MADE
WITHIN 15 DAYS AFTER RECEIPT OF GOODS. ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE: PRICES
PREVAILING ON TIME OF DELIVERY. THE GOODS COVERED BY THIS INVOICE WERE PRODUCED IN COMPLIANCE
WITH THE REQUIREMENTS OF THE FAIR LABOR STANDARDS ACT OF 1938 AS AMENDED.
THESE COMMODITIES ARE LICENSED FOR THE ULTIMATE DESTINATION SHOWN. DIVERSION CONTRARY TO THE
UNITED STATES LAW IS PROHIBITED. CUSTOMER HEREBY UNCONDITIONALLY AND WITHOUT RESERVATION AGREES
THAT GHC SPECIALTY BRANDS, LLC IS ENTITLED TO ENFORCE THE TERMS OF THIS SHIPPING ORDER UNDER THE LAWS
OF THE STATE OF ILLINOIS AND IN AN ILLINOIS FORUM.
VOUCHER 106329 WARRANT ALLOWED
179310 IN SUM OF
LAB SAFETY SUPPLY INC.
Acct 5208827
P.O. Box 5004
Janesville, WI 53547
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1016133558 01- 720H -08 $241.99
Voucher Total $241.99
Cost distribution ledger classification if
claim paid under vehicle highway fund
Prescribed by State Board of Accounts City Form No. 201 (Rev 1-495)
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
179310
LAB SAFETY SUPPLY INC. Purchase Order No.
Acct 5208827 Terms
P.O. Box 5004 Due Date 10/5/2010
Janesville, WI 53547
Invoice Invoice Description
Date Number (or rote attached invoice(s) or bill(s)) Amount
10/5/2010 1016133558 $241.99
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