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206425 02/14/2012 CITY OF CARMEL, INDIANA VENDOR: 276575 Page 1 of 1 ONE CIVIC SQUARE SAFETY SOLUTIONS, INC CARMEL, INDIANA 46032 PO Box 8100 CHECK AMOUNT: $264.00 DUBLIN OH 46016 -2100 CHECK NUMBER: 206425 CHECK DATE: 2/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 2092649 145.00 OTHER EXPENSES 651 5023990 2095985 134.00 OTHER EXPENSES 651 5023990 2097173 110.00 OTHER EXPENSES 651 5023990 297174 125.00 OTHER EXPENSES j n rrw rni i eT1nK1 f 02092649 INCORPORATED r Page 1 6161 Shamrock Ct. P.O. Box 8100 Dublin, OH 43016 -2100 800.232.7463 (Fax)800.237.4630 Dated 01/19/2012 Service Locations Atlanta, GA Birmingham, AL Buffalo, NY g Due Date; 02/03/2012 rll Columbus, OH Ft. Wayne, IN Greenville, SC Mobile, Pittsburgh, PA Rochester, NY Syracuse, NY Toledo, OH www.safetysolutions.com Sold To: 129700 Ship To: 1 w 'City Of Carmel City of Carmel Water Distribution Sewer Department 3450 W 131st ST 760 3rd Ave. SW, Suite 110 Westfield, IN 46074 Carmel, IN 46032 w Enh�, Customer: PO Number Release No& 4 F Salesperson Whse ShipDate Document Aaron Hoover Jason Barzak 01 0 01657117 �Te�ms k r Tax- Code FrelgFit Shlp Via 090* 77 11 E I Net 15 IN15 Prepaid Fedex Ground Intl Economy D. =E �E It Number iDescrlpUong Ordered Shipped Backorder UM Prlce, Per b Extension ap W 0100000234950120 1 1 0 PR 125.00 PR 125.00 2349 WOLVERINE SZ: 12M Aaron Hoover 01503012 1 1 0 PR 20.00 PR 20.00 030 MEGACOMFORT INSOLE SZ: 12 MENS SZ:12, WOMENS SZ: 14 Remit To: Safety Solutions, Inc. PO BOX 8100 Dublin, S H Tax Payments Total Due x: Dublin, OH 43016 -2100 145.00 0.00 0.00 145.00 1 r r �ry f n 1 1 r 5M. Invoice; 02097173 l sEE` E,€ ,U I M INCORPORATED 6161 Shamrock Ct. P.O. Box 8100 •Dublin, OH 43016 -2100 3R, 800.232.7463 (Fax)800.237.4630 Date 01/23/2012 Service Locations Atlanta, GA Birmingham, AL Buffalo, NY `V .�DueDate� 02/07/2012 re 'l l Columbus, OH FL Wayne, IN Greenville, SC Mobde, AL a Pittsburgh, PA Rochester, NY Syracuse, NY Toledo, OH www.safetysolutions.com Sold Tom =129700 Ship To: 1 `K City Of Carmel City of Carmel Water Distribution Sewer Department 3450 W 131st ST 760 3rd Ave. SW, Suite 110 Westfield, IN 46074 Carmel, IN 46032 t U E Customer PO Number Releami ]No Sales erson Whse� ShI Date Document aron Hoover Jason Barzak 01 01/23/2012 01657640 Terms Tax Code F�elgFt (�E E Shlp `Via M x^ a�. sin E a IN15 Prepaid Fedex Ground Intl Economy Item Number Description Ordered Sh�pped Backorder UM Price er Extension �s. ...�5 �t V,�111.. 0100000243950120 1 1 0 PR 110.00 PR 110.00 2439 WOLVERINE SZ: 12M Aaron Hoover Shipping warehouse: 90 w Remit To: Safety Solutions InC. Merchandise"; S H Tax Payme s�Ttital Due PO Box 8100 Dublin, OH 43016 -2100 110.00 0.00 0.00 110.00 fj' f 4 rly rni i iTinKI r 5M E 4 n�oic 02097174 INCORPORATED page 1 6161 Shamrock Ct. P.O. Box 8100 Dublin, OH 43016 21001E 800.232.7463 (Fax)800.237.4630 11 Date 3" 01/25/2012 Service Locations 3 Atlanta, GA Birmingham, AL Buffalo, NY M IN` D ate 02/09/2012 Columbus, OH Ft Wayne, IN Greenville, SC Mobile, AL Pittsburgh, PA Rochester, NY Syracuse, NY Toledo, OH www.safetysolutions.com Sold To x;129700 Ship To: 1 ��'City Of Carmel City of Carmel Water Distribution Sewer Department 3450 W 131st ST 760 3rd Ave. SW, Suite 110 Westfield, IN 46074 Carmel, IN 46032 'fi U erP,O�Nu ,her Release No Salesperson �t Whse Ship Date g Document Aaron Hoover Jason Barzak 01 01/25/2012 01657643 a a W s Tax Codes Freight ,Ship VI f� Mrs s EE.a..._' I.at, .?•a- ..,..y. ,c. .k--,_ L.i stt4 x Vin. ."x.'�n, s Net 15 IN15 Prepaid Fedex Ground Intl Economy r Item Number�Description,E Ordered Shipped zk Backorder UM�� Price r Per; Extens on ..;�u�:w �..u.- :.-t Rq, _fir, :.t. RMA SS10892 0100000234950120 1- 1- 0 PR 125.00 PR 125.00- 2349 WOLVERINE SZ: 12M Aaron Hoover Remit To: Safety Solutions Inc. "Merchandise S H Taxi Pa ents Total PO Box 8100 y Dublin, OH 43016 -2100 125.00- 0.00 0.00 125.00- f A CCTV M1 I U10KI f 5M R i o ce 02095985 INCORPORATED 6161 Shamrock Ct. P.O. Box 8100 Dublin, OH 43016 -2100 800.232.7463 (Fax)800.237.4630 bdaDa 01/24/2012 Service Locations Atlanta, GA Birmingham, AL Buffalo, N Y xx Due Date�� 02/08/2012 Columbus, OH Fl. Wayne, IN Greenville, SC Mobile, AL `f Pittsburgh, PA Rochester, NY Syracuse, NY Toledo, OH www.safetysolutions.com Sold To 129700 Ship To: 1 City Of Carmel City of Carmel Water Distribution Sewer Department 3450 W 131st ST 760 3rd Ave. SW, Suite 110 Westfield, IN 46074 Carmel, IN 46032 �CustomerPO�Number Release No xSalesperson 4�Whse ESh�p� Date, x Document t- P,aron- Hower Jason Barzak —01 01/24/2012 0-1657-2- v ..Y,E .T� For a:, a k Y Teems Tax Freight Code Shlp�Ula ���..�u� ?•;;:�,.4 t. �*,te..`. �al�� �'nr �',a. �E -F� pia t,�, �s` d Net 15 IN15 Prepaid Fedex Ground Intl Economy a,�� Item, Number /F Description E E Ordered I, Shipped t Backorder UM Price �Per�Extension �.S E UZI 0100000669680130 1 1 0 PR 134.00 PR 134.00 6696 ROCKY SZ: 13W Darryl Direct from Vendor i Solutions, Inc. p E Y Mrchises S3 H Tax ti Pa iemit To: Safety and yments TotalDue PO Box 8100,.. I AEI.. ....4 E,� E.a Dublin, OH 43416 -2100 134.00 0.00 0.00 134.00 E 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 276575 SAFETY SOLUTIONS, INC Purchase Order No. PO BOX 8100 Terms DUBLIN, OH 46016 -2100 Due Date 2/7/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 2/7/2012 2092649 $20.00 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 VOUCHER 116748 WARRANT ALLOWED 276575 IN SUM OF SAFETY SOLUTIONS, INC PO BOX 8100 DUBLIN, OH 46016 -2100 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code no-06) 2092649 01- 7200 -01 $20.00 logJ113 it t I ©.OLD 13 Voucher Total 0 Cost distribution ledger classification if claim paid under vehicle highway fund