203065 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 00350856 Page 1 of 1
ONE CIVIC SQUARE LEHIGH SAFETY SHOES CHECK AMOUNT: $104.99
CARMEL, INDIANA 46032 PO BOX 371958
PITTSBURG PA 15250 -7958 CHECK NUMBER: 203065
CHECK DATE: 10/25/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 681176 104.99 OTHER EXPENSES
7407532123 Lehigh 02:41:56 p.m. 10 -19 -2011 111
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Lehigh Outfitters, LLC
39 East Canal Street Duplicate Invoice
Nelsonville, Ohio 45764
Sold To: Ship To;
CARMEL WATER& WASTEWTR kevin buhmann
TREATMENT PLANT CARMEL WATER& WASTEWTR
760 3RD AVE. SW 9609 HAZEL DELL PKWY
CARMEL IN 46032 INDIANAPOLIS,IN 46280
Invoice# Invoice Date Cust.No. Customers Order Number Mobile -Unit Terms
681176 11 /02/10 085R93 00000 027288 LH #5440 IND TRK 194 (SHTL) 30 DAYS N£T
ales Employee mployee Da t S I Siz Uri Mero AdI Sale, Sery Lin Cas Company Employe
SIi Id ame p ty I'tic Am Am Tax Am Freigh TotaE Rec Subsidy gal Due D ed
14764 NEVIN 13U1 {MANN R6074 W It 1 104.9 104,99 104.99 1 1049
Total Qty Total Merchandise Adjustment Sates Tax Sery Fee. Freight Cash He, Company Subsidy Amount Due
1 104.99 104.99 104,99
Duplicate Invo (LZ1TFmm6M.- 10 PM- ry.0003)
To assure proper credit Please detach this portion and return with remittance.
REMITTANCE ADVICE
Invoice To: Customer 1508589300000
Invoice No 681176
CARMEL WATER& WASTEWTR Invoice Date 11/02/10
TREATMENT PLANT PLEASE REMIT PAYMENT TO: Amount Due 104.99
760 3RD AVE. 9W
CARMEL IN 46032 Lehigh Outfitters, LLC
P.O. BOX 644755 Amount Paid
PITTSBURGH, PA 15264 -4755
1508589300000 681176 110210 00010499 2
VOUCHER 116088 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
681176 01- 7202 -06 $104.99
Voucher Total $104.99
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.Q. Box 371958 Terms
Pittsburgh, PA 15250 Due Date 10/21/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/21/201' 681176 $104.99
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
Date Officer