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178313 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1 ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $466.58 CARMEL, INDIANA 46032 PO BOX 4250 o UTICA NY 13504 CHECK NUMBER: 178313 CHECK DATE: 10/14/2009 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1125 4239012 P25209790000 466.58 SAFETY SUPPLIES NORTHERN Remember... We Always Offer Our Lowest Price When You Order PLEASE REMIT TO. PO Box 4250 •Utica, NY 13504-4250 100% Satisfaction Guaranteed! NORTHERN Si4FETY CO., -INC. Phone: 800.631 .12A6 Fax: 800.635. 1591 P.O.-Bo r� northernsafety.com Utic N 1.3504 -4250 SHIP TO (IF OTHER THAN "SOLD TO YOUR CUSTOMER ID PLEASEREFERJO�YOUR YOUR CUSTOMER ID, OUR INVOICE AND ORDE R AO.' IN ALCCOMMUN16ATIONS REGARDING THIS INV OICE-- 0004816021 600 l 8 3 S �p TO CARMEL CLAY PARKS RECREATION 1411 E 116TH ST CARMEL, IN 46032 (22579� 09/15/09 L YOUR PURCHASE ORDER NUMBER AND DATE OUR INVOICE OJORDER NO. INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 10/16/09 P2252097900006 �09/_16./_0� UPS GROUND 09/15/09 IF PAID BY 10/06/09 PAY $961.34 ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT 7 7 152 -7700 L 01 EA HALF MASK SILICONE RESPIRATOR 7700 -30 LARGE 22.69 158.830 3 3 152 -7700 M 01 EA HALF MASK SILICONE RESPIRATOR 7700 -30 MEDIUM 22.69 68.07 1 1 166 -22593 01 EA NS PREMIUM FULL HARNESS W /BK SIDE D RING 7009 68.95 68.95 1 1 156 -7007 01 BX ALLEGRO RESPIRATOR WIPE PADS NO ALCOHOL100 /BX 13.15 13.15 12 12 156 -7019 01 EA RESPIRATOR STORAGE BAG 14 "X16" W /ZIPPPER 3.59 43.08 10 10 153 -3951 01 PK NORTH ACID GAS CARTRIDGE 2 /PK N75002 11.45 114.50 1 1 156 -2207 01 EA RESPIRATOR TRAININGAND FIT TESTING C ASE FT20 514.38 514.38 Purchase 9 aLl -0 9 Description C-1 �'j DY) P.O. P r F p-� �Ci 1J C7�L L G.L. 12 6,58 On J Budget Line Des Su y;�1 )1 6n ©1 Ce. Th e- baJ o Purchaser Date W be- P,_)Q. 'd- App DaW_ ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 1 12% PER SALES TAX SHIPPING HANDLING MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE UNPAID BALANCE. J Payments must be payable in US dollars only 2% discount does not apply to credit card payments Thank You for Your Order =1COA1 IM4 iC 17i A01A ACCOUNTS PAYABLE VOUCHER A CITY OF CARMEL An invoice of 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. 226500 Northern Safety Co., Inc. Terms P.O. Box 4250 Utica, NY 13504 -4250 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 9/16/09 P252097900006 Safety supplies 22579 466.58 Total 466.58 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 No. 226500 Northern Safety Co., Inc. Allowed 20 P.O. Box 4250 Utica, NY 13504 -4250 In Sum of .:o 466.58 ON ACCOUNT OF APPROPRIATION FOR 101 -General fund PO# or INVOICE NO. ACCT #TrITLE AMOUNT Board Members Dept 1125 P252097900006 4239012 466.58 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 7 -Oct 2009 Signature 466.58 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund