191271 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 179310 Page 1 of 1
ONE CIVIC SQUARE LAB SAFETY SUPPLY INC CHECK AMOUNT: $305.88
CARMEL, INDIANA 46032 Po Box 5004
JANESVILLE VIA 53547 -5004 CHECK NUMBER: 191271
CHECK DATE: 10/27/2010
DEPARTMENT ACCOUNT PO NUMBER INVO NUMBER AMOUNT DESCRIPTION
651 5023990 1016217658 305.88 MATERIALS SUPPLIES
Order 13v Phone. 1- 900 -3�,6 -0783 Lab Sa €uty Suppiv
Order 0111iile_ www.1 SS.oum 11"14; 39- 172621.9
Order 13N' Fas 401 S. W ight R& 1- SUQ- X43 -9)lU hillemille W1 U.S.A. 53547 -1368
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LAB SAFETY SUPPLY
PO tlo\ 1365
lunas�ille, %VI US:A 53547 -1368
002483 PAGE 1 OF 1
B CITY OF CARMEL s CITY OF CARMEL
i
L ACCOUNTS PAYABLE I ATTN: PAUL ARNONE
L 760 3RD AVE SW P 901 N RANGE LINE RD
T CARMEL IN 46032 -2072 T HOUSEHOLD HAZ WASTE
0 0
I 'l CARMEL IN 46032 -1361
Order No. P.O. No. Sold To No. invoice No. Invoice Date Due Date
SC07345195 ARNONE100710 5208827 1 1016217658 10/07/2010 11/06 /2010
Buyer Carrier Freight Terms Ship Date Payment Terms
AR.NONE,PAUL UPSGND LOCKED 1 10/07/2010 Net 30
QTY. QTY.
LINE PRODUCT NO. DESCRIPTION B.O. SHIP UOUNT AMOUNT
1 121947L GLV EXAM SYNETRON PWDRF LATE 0 20 BX 14.70 294.00
SUBTOTAL: 294.00
Thank you for your order. FREIGHT: 11.88
TAXES: 0.00
PN9365638031 ML
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 11/06/2010 305.88 USD
These items are sold for domestic consumption in the United States. If exported, purchaser
assumes full responsibility for compliance with US export controls.
ORIG
e
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 106414 WARRANT ALLOWED
r
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
1016217658 01- 7200 -02 $305.88
Voucher Total $305.88
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
179310
LAB SAFETY SUPPLY INC. Purchase Order No.
Acct 5208827 Terms
P.O. Box 5004 Due Date 10/18/2010
Janesville, WI 53547
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/181201( 1016217658 $305.88
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
Y
Date Officer