204568 12/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
ji CHECK AMOUNT: $403.42
CARMEL, INDIANA 46032 PO BOX 877
BELMONT MS 38827 CHECK NUMBER: 204568
CHECK DATE: 12/13/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0113509 -IN 403.42 UNIFORMS
INVOICE PAGE: 1
HALSEN PRODUCTS�COMPANY
P.O. BOX 877
BELMONT, MS 38827
NATIONWIDE 1-800 344 -6696 INVOICE NUMBER: 0113509 IN
FAX 1- 800 826 -8839 11/30/2011
INVOICE DATE:
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
i t CUSTOME,R SHIPVIAr 3,. >y r, F0 B .i:._� r y TERMS It
r� Y�
BONNIE UPS Net 30
IT NO UNITS ORDERED SHIPPED BACK ORDER PR a AMOUNT
r
F8750 -M EACH 6 6 0 7.750 46.50
T/G P/S HI VIZ THINSULATE LINE
F8750 -L EACH 34 34 0 7.750 263.50
T/G P/S HI VIZ 7HINSULAFE LINE
F8750 -X EACH 10 10 0 7.750 77.50
T/G P/S HI VIZ 1HINSULATE LINE
et—Lri V.oic.e_• 3.8_7_._5_0
Less= Discounts 0.00
Ffeightji 15.92
THANK YOU FOR YOUR ORDER
t Sales' Tax 0.00
Invo�ce _T :otali 403.42
Less Deposit 0.00
x 403.42
INVOICE BALANCE
I
VOUCHER NO. WARRA NO.
Halsen Products ALLOWED 20
IN SUM OF
P. O. Box 877
Belmont, MS 38827
$403.4
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT
Board Members
2201 0113509 IN 43 560.01 $403.42 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
4Friday, D�ecembe4 09, 2011
v v Street Commissioner
Street 4FjTmmissioner
Cost distribution ledger classification if
claim paid motor 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 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))
11/30/11 0113509 -IN $403.42
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