162027 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: 276575 Page 1 of 1
0 ONE CIVIC SQUARE SAFETY SOLUTIONS, INC
CARMEL, INDIANA 46032 PO BOX 6100 CHECK AMOUNT: $129.00
DUBLIN OH 46016 -2100 CHECK NUMBER: 162027
CHECK DATE: 7/23/2008
DEPART ACC PO NUMBER INVOICE NUMBE A MOUNT DESCRIPTION
651 5023990 1336781 129.00 MAT SUPP -HAZ MATERI
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1 1 (n' B ��"1�' 6161 Shamrock Ct.• P.O. Box 8100 L fi E
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Dublin, OH 43016 -2100 {Invoice Zvi 01336781
INCORPORATED 800.232.7463 (fax)614.799.9901 a tva rr^z a j
Regional Offices &Distribution Centers �c Pa ge wz a 04 1
Birmingham, AL Mobile, AL Columbus, OH Toledo,
OH 07/02/2008
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866.241.9399 888.877.7463 800.232.7463 419.360,9900.
Date z
Pittsburgh, PA Syracuse, NY Auburn, IN
800.562.0555 800.836.7463 260.927.1956 n
a� 'Due =Date 07/17/2008
Salii,;To: 129700 Ship To: 129700
"City Of Carmel City Of Carmel
Water Distribution 901 North Rangeline
3450 W 131st ST Carmel, IN 46074
Westfield, IN 46074
ih -i omer t e u ease No �4� fk d zj Y�h�
Salesperson d seShlp Date Document
Cust PO Nmb Rel w F 3
William Kellam Jasoni Sarzam 01 07/02/2008 013397
Tax Code x F Shlp V
'Freight'.
Net 15 IN15 Prepaid Fedex Ground
?-r fcttem *NUITlberki'1`�- "r M... p u� .x�- cart, ....:A' 5 ..:i`�- s': =�t"a v+ o t^. d :€�.r.� 'p r
I Descn tion Ordered.$hl ed Backortler, UM s P Per KExtenslon
.:...c'.; :cry "t'u pp
ia.�:4..;x r v. -t�Y..
0100000163050090 1 1 0 PR 129.00 PR 129.00
1630 WOLVERINE 9M
Kellam, William
Taxes:
INDIANA 3
Remit To: Safety Solutions, Inc. p' ?N ents
PO BOX 8100 Merchandise �iS W,' f Taxi k �P -g �To�t�als Due
ar. 1 P a <t,.: Y sx x�a, team
Dublin, OH 43016 -2100 129.00 0.00 .03 38.03
VOUCHER 085925 WARRANT ALLOWED
276575 IN SUM OF
SAFETY SOLUTIONS, INC
PO BOX 8100
DUBLIN, OH 46016 -2100
r
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1336781 01- 720H -08 $129.00
I
1
Voucher Total $129.00
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
276575
SAFETY SOLUTIONS, INC Purchase Order No.
PO BOX 8100 Terms
DUBLIN, OH 46016 -2100 Due Date 7/15/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/15/2008 1336781 $129.00
hereby certify that the attached invoice(s), or bill(s) is (are) true and
brrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer