161005 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
y� CHECK AMOUNT: $164.73
CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 161005
CHECK DATE: 6125/2008
DEPART ACCO UNT PO N IN VOICE NUMBER AMOUNT DESC RIPTION!
601 5023990 DP2121541010 164.73 6200.03DENSES
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r
Remember... We Always Offer
Our Lowest Price When You Order. PLEASE REMIT To':
Safety and Industrial Supplies 1 00% Satisfaction Guaranteed. NORTHERN SAFETY C;O INC.
P.O. Boz
PO Box 4250 Utica, NY 13504 -4250
Phone: 800, 631 1246 Fax: 800. 635. 1591 Utica, NY 7.3504 4250
northernsafety.com
SHIP TO (IF OTHER THAN "SOLD TO
PLEASE RE�ER TO YOUR YOUR CUSTOMER ID, OUR INVOICE AND YOUR CUSTOMER ID I J ERRY CLOUD
O 0002411866 CITY OF CARMEL
UTILITIES DEPT
SOLD 3450 W 131ST ST
TO CITY OF CARMEL WESTFIELD, IN 46074
ATTN UTILITIES DEPT
3450 W 131ST ST L
WESTFIELD, IN 46074
JERRY 06/02/08
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED P
INVOICE NOJORDER NO. AYMENT DUE BY 07 /08
P212154101013 06/02/08 UPS GROUND 06/02/.08 IF PAID BY 06/22/08.PAY .$161.67
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
12 12 110 -24224 PM 01 EA AXEL BLUE MIRROR LENS WfCARRY CASE PLAT /FRAME 6.89 82:68
12 12 100 26497 01 EA NEMESIS EYEWEAR BLUE MIRROR BLACK FRAME 19808 5.86 70.32
1 1 325 -01 CATALOG 01 EA NEW CUSTOMER CATALOG KIT NC071 QO
SALES TAX SHIPPING &HANDLING
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 PER
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE 11.73 164.
UNPAID BALANCE.
Payments must be payable in US dollars only
2% discount does not apply to credit card payments Thank You for Your Order!
CF-nCOAI Ir)4f 19.`_101AR1A
Prescribed by State Board of Accounts
FormNo.,,�o,(Re ".'995' ACCOUNTS PAYABLE VOUCHER
TO
ADDRESS
Invoice Date Invoice Number Item Amount
I 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
Mo. Day vr. Signature Title
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.
Mo. Day Yr. Officer Title
Voucher No. Warrant No.
r ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ACCT.
NO. t:
CARMEL, INDIANA
F Of
OD
�1 LA I as
Total Amount of Koucher
D
P X01
Amount of arrant g
Month of Yr
Acct.
VOUCHER REC D No.
Source of Suppl
Water Treatment
Transmission and Dist.
Customer Accounts
Administrative and General
Operation-Maintenance
Utility Plant in Service
Constr. Work in Progress
Materials and Supplies
Customers Deposits
Total
Allowed
Board of Control
Filed
Official Title
ROYCE FORMS SYSTEMS 0- 800- 382 8702 325