163837 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 00350856 Page 1 of 1
ONE CIVIC SQUARE LEHIGH SAFETY SHOES
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CARMEL, INDIANA 46032 PO BOX 371958 CHECK AMOUNT: $289.97
PITTSBURG PA 15250 -7958 CHECK NUMBER: 163837
CHECK DATE: 9/1712008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 S11383 326702 289.97 BOOTS
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Rocky Brands Retail LLC Cust.No. Report Invoice Date Invoice#
39 East Canal Street
Nelsonville, Ohio 45764 085893 00000 00268 08/27/08 326702
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
Customers Order Number SM Mobile -Unit Order Date Tenns
85 027288 LH #5378 IND TRK 194 08/25/08 30 DAYS NET
Line I Ticket Employee Id Employee Name Dept Other Amount Due
Style WD I Size I Qty I Price I MDSE Amt Adjust 'Pax I Sere Chg. Mise Total Sale I Cash Reevd Subsidy I Emp Bal DED
1 006251 jordan kleinsmith
61009 w II 1 99.99 99.99 99.99 99.99
2 006252 jell kozlovich
26063 M 10.5 1 124.99 124.99 124.99 124.99
3 006253 nonnan riley
5235 w 7.5 1 64.99 64.99 64.99 64.99
Total Qty Merchandise Value Adjustment Tax Sery Chg Misc Cash Rec Company Subsidy Amount Du l ?RQ Q7 7R4 4'7 �RQ
VOUCHER 086227 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
326702 01- 7202 -05 $289.97
Voucher Total $289.97
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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
350856
LEHIGH SAFETY SHOES CO. Purchase Order No.
P.O. Box 371958 Terms
Pittsburgh, PA 15250 Due Date 9/8/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
9/8/2008 326702 $289.97
c
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