160500 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $2,573.67
CARMEL, INDIANA 46032 PO Box 4250
UTICA NY 13504 CHECK NUMBER: 160500
CHECK DATE: 6/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO D ESCRIPTION
1047 4239012 P21018900101 2,573.67 SAFETY SUPPLIES
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Remember... We Always Offer
�i Our Lowest Price When You Order. PLEASE REMIT
Safety and Industrial Supplies 100% Satisfaction Guaranteed! NORTHERN SAFETY CO. INC
P.O. BOX
PO Box 4250 Utica, NY 13504 -4250 04
Phone: 800. 631 1246 Fax: 800, 635 1591 Utica, NY 13504 4 4250
northernsa fety. com
SHIP TO (IF OTHER THAN "SOLD TO
PLEASE REFER TO YOUR YOUR CUSTOMER ID FARMEL/CLAY PARKS AND REC
INVO
ORDER NO. IN ALL 0004816021 ATTN: TINA HOTZE
1235 CENTRAL PARK DR EAST
TOL �ARMEL CLAY PARKS RECREATIO RECEIVED CARMEL IN 46032
1411 E 116TH ST AY 1 2008 L
CARMEL IN 46032 M
BYE i 18051 05/12/08
L JUN U 3 2008 YOUR PURCHASE ORDER NUMBER AND DATE
OUR
INVOICE NOJORDER NO. INVOICE DATE SHIPPED VIA IJATE SHIPPED PAYMENT DUE BY_ 06/11/08
P210189001018 05/12/08 UPS GROUND 05/12/08 IF PAID BY 06/01/08 PAY $2,522.20
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
5 5 249 -2372 01 BX ACTIVE STRIPS KNEE ELBOW PATCH 10 /BX 510 -10 4.02 20.I0
25 25 249 -1602 01 BX KNUCKLE BANDAGE 1 112 X 3 100 /BX 8.49 212.25
100 100 249 -6115 Ol EA STRETCH GAUZE BANDAGE 2 "X 2 YDS 1.81 181:00.
1 1 249 -7259 01 BX STERILE PADS 21 2" 100 /BX 7260033 8.62 8.62
1 1 249 -7280 01 BX STERILE PADS 4 "X 4" 100 /BX 7280033 15.91 15.91
1 1 249 -9305 01 BX EYE PADS 2 1/8 X 2 5/8 50 /BX WHITE CROSS 17570 12.65 12.65
2 2 249 -5123 01 BX ZONAS POROUS TAPE 1 12" X10 YDS 24 RL /BXJ &J 16.15 32.30
1 1 249 -24502 01 BX 3M DURAPORE HYPOALLERGENIC TAPE 1 /2 "X10YD 24 /BX 15.72 15.72
20 20 250 -1802 01 BX ALCOHOL PREP PAD LARGE 100 /BOX 10 -3002 3.33 66.60
1 1 250 -730 01 BX NEOSPORIN FIRST AID OINTMENT DISPENSER 144/BX 46.54 46.54
1 1 252 -4409 BE 01 EA EMT PARAMEDIC SCISSORS 7 112" BLUE 5.50 5.50
24 .24 109 -4113 01 EA EYESALINE PERSONAL EYE WASH I OZ BOTTLE 451 (17 2.07 49.68
960 960 252 -24487 01 EA INSTA -KOOL HazMat FREE 5 "0" ICE PACK JUNIOR 99 950.40
60 60 122 -19920 L 01 BX FLEXSHIELD 8MIL PF NITRILE GLOVES LG PFNT -12LG 10.45. 627.00
6 6 253 -25013 OF 01 EA TRAUMA BAGS LARGE ORANGE 13438 54.90 329.40
SALES TAX SHIPPING HANDLING�^m
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 1 /2% PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE 2,
UNPAID BALANCE.
Payments must be payable in US dollars only
"2% discount does not apply to credit card payments Thank You for Your Order!
=MCDAI ine 1a_1D1AQ1n
ACCOUNTS PAYABLE VOUCHER
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.
Northern Safety Co., Inc.
P.O. Box 4250 Date Due
Utica, NY 13504 -4250
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5112108 P210189001018 Safetv Supplies 2,573.67
Total 2,573.67
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
20�
Clerk- Treasurer
3
oucher No. Warrant No.
Allowed 20
Northern Safety Co., Inc.
P.O, Box 4250
Utica, NY 13504 -4250 In Sum of
2,573.67
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO, ACCT #ITITLE AMOUNT Board Members
Dept
1047 P210189001018 4239012 2,573.67 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
4 -Jun 2008
Signature
2,573.67 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund