203009 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $2,732.37
BELMONTMS 38827 CHECK NUMBER: 203009
CHECK DATE: 10/25/2011
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239011 0112930 -IN 2,732.37 SPECIAL DEPT SUPPLIES
HALSEN PRODUCTS COMPANY NVMCE PAGE: 1
P.O. BOX 877
BELMONT, MS 38827
NATIONWIDE 1- 800 -344 -6696 INVOICE NUMBER: 0112930 -IN
FAX 1 -800- 826 -8839 INVOICE DATE: 10/13/2011
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
SOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ACCOUNTS PAYABLE DEPT BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
Li7STOMER "F.O: FQB TFiNIS�
BONNIE UPS Net 30
ITEM NO. UNIT -0RDERED SHIPPER BACK ORDER PRICE AMOUNT
TC- 18FLBB EACH 200 200 0 4.800 960.00
18" TRAFFIC CON W /BLA K BASE
650Rl -0 EACH 50 50 0 28.900 1445.00
NAVICADE CHANNE IZER C NE
650 -RB16 EACH 28 28 0 0.000. 0.00
NAVICADE 16LB B SE
EACH 22 22 0 0.000 0.00
NAVICADE 16LB BASE
EACH 1 1 0 0.000 0.00
4" WHITE EG STR PE ON CONE
Ne -t Invoice 2A.0.5-0-0—
Less- Discount,: 0.00
THANK YOU FOR YOUR ORDER Freight: 327.37
Sales Taxi 0.00
Invoice Total: 2732.37
Less Deposit: 0.00
2.7 -3 2 3 7
INVOICE BALANCE
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/13/11 0112930 -1N $2,732.37
1 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
20
Clerk- Treasurer
VOUCHER NO. WARRANT N
ALLOWED 20
Halsen Products
IN SUM OF
P. O. Box 877
Belmont, MS 38827
$2,732.37
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 0112930 -IN 42- 390.11 $2,732.37 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
1 �jThursday(Octdber 20, 2011
L01 r
Street Commissiork /I/
Street C;tar
Cost distribution ledger classification if
claim paid motor vehicle highway fund