191300 10/27/2010 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
a ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $161.77
CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 191300
CHECK DATE: 10/2712010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1125 4239012 705709150101 161.77 SAFETY SUPPLIES
AJORTHERN Remember... We Always Offer
Our Lowest Price When You Order. PLEASE REMIT TO:
PO Box 4250 Utica, NY 13504-4250 100% Satisfaction Guaranteed! NORTHERN SAFETY CO., INC.
Phone: 800. 631 .12A6 Fax: 800.635. 1591 P.O. Box 4250
northernsafety.aom Utica, NY 13504 -4250
SHIP TO (IF OTHER THAN "SOLD TO
YOUR CUSTOMER ID FCARMEL CLAY PARKS RECREATION uR INVOICE AND :PLEASE REFER
NO. IN ALL COMMUNICATIONS REGARDING THIS INVOICE 0004816021 1411 E 116TH ST
CARMEL, IN 46032
TO O CARMEL CLAY PARKS RECREATION
1411 E 116TH ST
CARMEL, IN 46032 L
10/12/10
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 11/11/10
INVOICE NO./ORDER NO.
1057091501016 10/12/10 UPS GROUND 10112110
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
100 10 134 -19874 01 PR POLYETHYLENE COATED SLEEVES 100PR /CS PS -CPE .39 39.00
100 10 134 -19867 01 EA POLYETHYLENE COATED APRONS 28 "X 40" AP102 -CPE .84 84.00
1 150 -26622 01 BX N95 HEALTH CARE PARTICULATE RESP. #1860 BX /20 21.49 21.49
Purchase
Description
P.O.# PorF
G.L.
Budget OC 8 2010
Line Descr
Purchaser Date
Approval Date BY
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 PER SALES TAX SHIPPING 8 HANDLING
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE 17
UNPAID BALANCE.
Payments must be payable in 05 dollars only
`2% discount does not apply to credit card payments Thank Y ®u for Y our Order?
FEDERAL JD# 16- 1214814
ACCOUNTS PAYABLE VOUCHER
r CITY OF CARMEL
An invoice of 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.
226500 Northern Safety Co., Inc. Terms
P.O. Box 4250
Utica, NY 13504 -4250
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
10/12/10 1057091501016 Safety supplies 161.77
Total 161.77
1 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
1 20_
Clerk- Treasurer
Voucher No. Warrant No.
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504 -4250
In Sum of$
i) 161.77
ON ACCOUNT OF APPROPRIATION FOR
101 -General
PO# or INVOICE NO. ACCT #ITITLE AMOUNT Board Members
Dept
1125 1057091501016 4239012 161.77 E 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
21 -Oct 2010
Signature
161.77 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund