162403 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 179310 Page 1 of 1
ONE CIVIC SQUARE LAB SAFETY SUPPLY INC
CARMEL, INDIANA 46032 PO BOX 5004 CHECK AMOUNT: $584.11
JANESVILLE WI 53547 -5004
CHECK NUMBER: 162403
CHECK DATE: 8/7/2008
DEPARTMENT ACCOUNT PO N UMBER INVOIC NUMBER AMOUNT DESCRIPTION
651 5023990 S11199 1011875983 584.11 CART, GLOVES
Order By Phone: 1 -800 356 -0783 Lab Safety Supply Inc.
Order Online: www.LSS.com PEI A 39- 1726218
SM Order By Pax: 1- 800- 543 -9910 401 S. Wright Rd. GST 8 1 1 0 Box 1368
Technical Support: 1 -800- 356 -2501 Janesville Wl U.S.A. 53547 -1368
LAB SAFETY SUPPLY
PO Box 1368
Janesville, WI USA 53547 -1368
a 003868 PAGE 1 OF 1
CITY OF CARMEL S, CITY OF CARMEL
ACCOUNTS PAYABLE :y'< 901 N RANGE LINE RD
760 3RD AVE SW HOUSEHOLD HAZ WASTE
CARMEL IN 46032 -2072 CARMEL IN 46032 -1361
der., X30. Invoice Nbd 1nu lice Hate... pue:0 0
SCO3494579 KELLAM07222008 5208827 1 1011875983 07/22/2008 08/21/2008
�Y>3r Cares @rre�ght: frrr�s Ships DafB Pa�irneni 7r��rr5
KELLAM,BILL UPSGND PP ADD 07/22/2008 Net 30
Q Y Q 11f�
;L {�fE PRQaUCT Np 8 SCR PT[pN
B. Gx H1P U Q.M A UI�T AMOUNT
1 135679 UTLTY CRT ECNMY 2 SHLF BL 31 0 3.00 EA 123.00 369.00
2 121949L GLV EXAM MICRO ONE LATEX LRG 0 20.00 BX 7.40 148.00
SUBTOTAL: 517.00
Thank you for your order. FREIGHT: 67.11
TAXES: 0.00
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 08/21/2008 584.11 USD
ORIGINAL
After 90 days from invoice date, Lab Safety Supply, Inc. will not be responsible to show proof of delivery.
TITLE TO ALL MERCHANDISE SHIPPED PASSES TO THE PURCHASER UPON DELIVERY TO THE COMMON CARRIER.
NO CLAIMS, DEDUCTIONS OR RETURNS ACCEPTED WITHOUT OUR WRITTEN CONSENT. ALL CLAIMS MUST BE MADE
WITHIN 15 DAYS AFTER RECEIPT OF GOODS. ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE; PRICES
PREVAILING ON TIME OF DELIVERY. THE GOODS COVERED BY THIS INVOICE WERE PRODUCED IN COMPLIANCE
WITH THE REQUIREMENTS OF THE FAIR LABOR STANDARDS ACT OF 1938, AS AMENDED.
THESE COMMODITIES ARE LICENSED FOR THE ULTIMATE DESTINATION SHOWN. DIVERSION CONTRARY TO THE
UNITED STATES LAW IS PROHIBITED. CUSTOMER HEREBY UNCONDITIONALLY AND WITHOUT RESERVATION AGREES
THAT LAB SAFETY SUPPLY, INC. IS ENTITLED TO ENFORCE THE TERMS OF THIS SHIPPING ORDER UNDER THE LAWS
OF THE STATE OF WISCONSIN AND IN A WISCONSIN FORUM.
V UCHER 086007. WARRANT ALLOWED
179310 IN SUM OF
_AB SAFETY SUPPLY INC.
4cct 5208827
.O. Box 5004
Janesville, WI 53547
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
'O INV ACCT AMOUNT Audit Trail Code
1011875983 01- 720H -08 $584.11
1
Voucher Total $584.11
agst distribution ledger classification if
:laim 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
179390
LAB SAFETY SUPPLY INC. Purchase Order No.
Acct 5208827 Terms
P.O. Box 5004 Due Date 7/29/2008
Janesville, WI 53547
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/29/2008 1011875983 $584.11
iereby certify that the attached invoice(s), or bill(s) is (are) true and
)rrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer