155389 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00350856 Page 1 of 1
ONE CIVIC SQUARE LEHIGH SAFETY SHOES
CARMEL, INDIANA 46032 PO BOX 371958 CHECK AMOUNT: $349.45
PITTSBURG PA 15250 -7958
o CHECK NUMBER: 155389
CHECK DATE: 1/1012008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
6'51 R5023990 S10928 236726 84.74 BOOTS
651 RS023990 510928 236747 173.12 BOOTS
6.51 R5023990 S10928 236759 91.59 BOOTS
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S9 East Canal Street Cust.No. Report Invoice Date Invoice#
Nelsonville, Ohio 45764 085893 00000 00152 12/13/07 236726
Sold To: Ship To:
CARMEL WATER& WASTEWTR CARMEL WATER& WASTEWTR
TREATMENT PLANT TREATMENT PLANT
760 3RD AVE. SW 9609 HAZEL DELL PKNVY
CARMEL IN 46032 INDIANAPOLIS, IN 46280
Customers Order Number SM Mobile -Unit Order Date Terms r
s10928 85 447660 LEHIGH #5378- INDIANAPOLIS 12/10/07 30 DAYS NET
Line Ticket Employee Id Employee Name Dept Other Amount Due
Style WD Size I Qty Rice I MDSE Amt Adjust ru, set, Chg Mise 'Ibml Sale Cash Recvd Subsidy Emp But DED
1 004394 Gary LaPollett
5258 M 10 1 84.74 84.74 84.74 84.74
Total Qty Merchandise Value Adjustment Tax Se, Chg Misc Cash Rec Subsidy I Amount Due
1 84.74 1 1 1 84.74 84.74
ikgt b tl•i Invo ice were produced in compliance with the Fair Labor Standards Act of 11938 vc amended.
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1; safety shoes
'i9 East Canal Street Cust.No. Report Invoice Date Invoice#
Nelsonville, Ohio 45764 085893 00000 00154 1 12/13/07 236747
Sold To: Ship To:
CAR -KIEL 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
s10928 85 447660 LEHIGH #5378- INDIANAPOLIS 12/12/07 30 DAYS NET
Line I 'Picket Employee ld Employee Name Dept Other Amount Due
Style WD I Size I Qty Price I MDSE Amt Adjust 1'as 1 Sen Chg Mise 'Total Sale Cash Recd Subsidy Emp =ID
1 004411 Lonnie Patton
71391 12 1 89.05 89.05 89.05 89.05
2 004412 Pete Brennan
XPX861 W 9 1 84.07 84.07 84.07 84.07
Total Qty Merchandise Value Adjustment Tax Sery Chg Misc Cash Rec Subsidy I Amount Due
2 173.12 173.12 173.12
T4v by his I,=ice were produced in compliance with the Fair Labor Standards Act of 193R..a-,amznded.
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39 East Canal Street Cust.No. Repots Invoice Date Invoice#
Nelsomille, Ohio 45764 08589300000 00155 12/13/07 236759
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 Tenns
85 447660 LEHIGH #5378- INDIANAPOLIS 12/13/07 30 DAYS NET
Line Ticket Employee Id Employee Name Dept Other Amount Due
Style WD Size I Qty Rice I MDSE Amt Adjust Tax 1 Sen Chg Misc Total Snle Cash Recvd Subsidy Emp Bat DED
I 004445 Chtis Stub
1213 w II I 91.59 91.59 91.59 91.59
Total Qty Merchandise Value Adjustment Tax Sery Chg Misc Cash Rec Subsidy Amount Due
1 91.59 1 91.59 91.59
The 6nnric cnverarl by this 1 moo
VOUCHER 076942 WARRANT ALLOWED
""350856 o200 7 IN SUM OF
L >EHIGH 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
236726 01- 7202 -06 $84.74
oZ 36717 o I.7zv2,DS 173.1.2
23 67 5 9 o1, 7 2- 02.0 .6 9 5
34gM15
Voucher Total
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
t7
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 12/28/2007
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/28/200; 236726 $84.74
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
h 10?
Date Officer