192088 11/23/2010 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
0 o CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $376.15
BELMONT MS 38827
o o CHECK NUMBER: 192088
CHECK DATE: 11/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239012 0108909 —IN 376.15 SAFETY SUPPLIES
lJ OICE PAGE: 1
HALSEN PRODUCTS COMPANY
P.O. BOX 877
BELMONT. MS 38827
NATIONWIDE 1 -800- 344 -6696 INVOICE NUMBER: 0108909
FAX 1-800-826-8839
INVOICE DATE: 11/11/2010
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIPTO
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
"CUSTOtAEFR P.O. BHfP VIA FO:B TERMS
BONNIE UPS Net 30
ITEM NO. UNIT ORDERED SHIPPED-,- BACK'ORDER PRICE AMOUNT
EACH 24 24 0 4.400 105.60
ZONE II MATT BL /ICE OR3 MIRRO
EACH 24 24 0 4.600 110.40
ZONE II SILVER/ CE BLUE MIRROR
EACH 24 24 0 4.600 110.40
ZONE II SILVER ]CE ORG IRROR
EACH 12 12 0 3.100 37.20
MINI ZTEK BLUE MIRROR
363 -60
r Less Discount`: 0.00
THANK YOU YOUR ORDER Freight: 12.55
Sales Tax.: 0.00
Invoice Total: 376.15
Less Deposit: 0.00
1-5—
INVOICE BALANCE
VOUCHER NO. WARRANT NO.
ALLOWED 20
Halsen Products
IN SUM OF
P. O. Box 877
Belmont, MS 38827
$376.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 0108909 -1N 42- 390.12 $376.15 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
hursday, Nouember 18, 2010
I i F
s §gG s'ier
Title
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 Dumber (or note attached invoice(s) or bill(s))
11/11/10 0108909 -IN $376.15
l 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