156239 02/06/2008 CITY OF CARMEL, INDIANA VENDOR: 00350856 Page 1 of 1
ONE CIVIC SQUARE LEHIGH SAFETY SHOES CHECK AMOUNT: $479.95
,a CARMEL, INDIANA 46032 PO BOX 371958
PITTSBURG PA 15250 -7958 CHECK NUMBER: 156239
CHECK DATE: 2/6/2008
DEPARTMENT ACCOUNT PO NUMBER INV NUMBER AMOUNT DESCRIPTION
651 5023990 253556 479.95 OTHER EXPENSES
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LEHIG Call 1 -800- 444 -4086 For Your
Password to Access our Website Page 1
www.lehi ghfetysh
safety shoes sa oes.com 10
39,East Canal Street Cusl.No. Report Invoice Date Invoice#
Nelsonville, Ohio 45764 085893 00000 00039 01/28/08 253556
Sold To: Ship To:
CARMEL WATER& WASTEWTR CARMEL WATER& WASTEWTR
TREATMENT PLANT TREATMENT PLANT
760 3RD AVE. SW 9609 HAZEL DELL PKWY
CARMEL IN 46032 INDIANAPOLIS, IN 46280
Customer's Order Number SM Mobile -Unit Order Date Terms
85 029952 LH #5378 INDYTRK #432 01/28/08 30 DAYS NET
Line I Ticket Employee Id Employee Name Dept Other Amount Due
Style WD I Size Qty Rice MDSE Ann Adjust Tax Sere Chg Misc Total Sale Cash Recvd Subsidy Emp Bal DED
1 001846 paul amone
5097 M 9.5 1 99.99 99.99 99.99 99.99
2 001847 greg epp
R6003 W 9 1 89.99 89.99 89.99 89.99
3 001848 jon osbom
5041 W 10 1 89.99 89.99 89.99 89.99
4 001849 lany eidson
5258 W 14 1 109.99 10999 109.99 109.99
5 001850 aaron hoover
R6004 W 13 1 89.99 89.99 89.99 89.99
Total Qty Merchandise Value Adjustment Tax Sery Chg Misc Cash Rec Subsidy Amount Due
5
4 79.9 5 _479:95 479.95
The Goods covered by this Invoice were produced in compliance with the Fair Labor Standards Act of 1938, as amended.
Original Invoice (LEHForm6M 1(2912008 7:08:56 AM- rt 60002)
A
VO,JCHER 077243 WARRANT ALLOWED
350856 IN SUM OF
LEHIGH SAFETY SHOES CO.
P.O. Box 371958
Pittsburgh, PA 15250
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
253556 01- 7200 -01 $479.95
Voucher Total $479.95
;Cost distribution ledger classification if
?claim paid under vehicle highway fund
i
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER r
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
350856
LEHIGH SAFETY SHOES CO. Purchase Order No.
P.O. Box 371958 Terms
Pittsburgh, PA 15250 Due Date 2/4/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
2/4/2008 253556 $479.95
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer