178250 10/14/2009 CITY OF CARMEL, INDIANA VENDOR: 179310 Page 1 of 1
ONE CIVIC SQUARE LAB SAFETY SUPPLY INC CHECK AMOUNT: $23.84
CARMEL, INDIANA 46032 Po Box 5004
JANESVILLE W 53547 -5004 CHECK NUMBER: 178250
CHECK DATE: 10/14/2009
DEPARTMENT ACCOUNT PO NUMBER INV NUMBER AMOUNT DESCRIPTION
1047 4239012 1014178761 23.84 SAFETY SUPPLIES
Order By Phone: 1- 800 356 -0783 L,ah Safety Supply Inc.
Order Online: www.LSS.com FEI 9 39- 1726218
Order B Fax: 1 -800- 543 -991.0 GST4 894097476RT
SM y 401 S. Wright Rd. PO Box 1368
Technical Support: 1 -800- 356 -2501 Janesville WI 1J.S.A. 53547 -1368
LAB SAFETY SUPPLY
PO Box 1368
Janesville, WI USA 53547 -1368
003023 PAGE 1 OF 1
CARMEL CLAY PARKS S RECREATION 5 CARMEL CLAY PARKS RECREATION
>f.: H,
ACCOUNTS PAYABLE ATTN. CABBIE KEAVENEY /MDNON CTR
a 1411 E 116TH ST 1235 CENTRAL PARK DR E
CARMEL IN 46032 -3455 CARMEL IN 46032
Q:
t3rder i�o P �l Ake... 5a#ct Ta N17 Inm�ce N lnuQECe date acle t3aite
SCO5580845� 22624 6260182 2 1014178.7_6.1 0- 9./_2.3./ 20.0.9 10/23/2009
yrer Cant r l^r rgh T$r Fn$ .s Ship 'ajirrxgnt. 1 arms r.
GARSKE,SERRA UPSGND LOCKED 09/23/2009 Net 30
QTY QT�r UNIT
1�11[E PRCaUGT.ICJ dE €PTIQttt BH �.Q. Al#(NT AM3l1NT...
1 27240 FA WIPE BZK ANTISEPTIC 0 4 BX 3.30 13.20
Purchase
Description
P.O. PO no
GA- 9 coo- in0 -�a-3- as 6002 8 Z d3S
Bud
Line DesCr X0.5 Fr-;
Purchaser
Dam,,.,,...._ 111 �4
Approval Da
SUBTOTAL: 13.20
Thank you for your order. FREIGHT: 10.64
TAXES: 0.00
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 10/23/2009 23.84 PSD
r'
ORIGINAL
After 90 days from invoice date, Lab Safety Supply, Inc. will not be responsible to show proof of delivery
TITLE TO ALL MERCHANDISE SHIPPED PASSES TO THE PURCHASER UPON DELIVERY T d THE COMMON CARRIER.
NO CLAIMS, DEDUCTIONS OR RETURNS ACCEPTED WITHOUT OUR WRITTEN CONSENT. ALL CLAIMS MUST BE MADE
WITHIN 15 DAYS AFTER RECEIPT OF GOODS. ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE; PRICES
PREVAILING ON TIME OF DELIVERY. THE GOODS COVERED BY THIS INVOICE WERE PRODUCED IN COMPLIANCE
WITH THE REQUIREMENTS OF THE FAIR LABOR STANDARDS ACT OF 1938, AS AMENDED.
THESE COMMODITIES ARE LICENSED FOR THE ULTIMATE DESTINATION SHOWN, DIVERSION CONTRARY TO THE
UNITED STATES LAW IS PROHIBITED. CUSTOMER HEREBY UNCONDITIONALLY AND WITHOUT RESERVATION AGREES
THAT LAB SAFETY SUPPLY, INC. IS ENTITLED TO ENFORCE THE TERMS OF THIS SHIPPING ORDER UNDER THE LAWS
OF THE STATE OF WISCONSIN AND IN A WISCONSIN FORUM.
ACCOUNTS PAYABLE VOUCHER
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.
Lab Safety Supply Terms
P.O. Box SOUL
Janesville, WI 53547 5WA
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
9123109 1014178761 Antiseptic wipes 22624 F 23.84
Total 23.84
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
C
Voucher No. Warrant No.
Lab Safety Supply Allowed 20
P.O. Box 500zj
Janesville, WI 53547- 5004
In Sum of
23.84
ON ACCOUNT OF APPROPRIATION FOR
104 Program Fund
PO# or INVOICE NO. ACCT #TTITLE AMOUNT Board Members
Dept
1047 1014178761 4239012 23.84 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
23.84 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund