176317 08/19/2009 r�
CITY OF CARMEL, INDIANA VENDOR: 179310 Page 1 of 1
ONE CIVIC SQUARE LAB SAFETY SUPPLY INC
�4 CARMEL, INDIANA 46032 Po Box 5004
CHECK AMOUNT: $865.34
JANESVILLE WI 53547 -5004
CHECK NUMBER: 176317
CHECK DATE: 8/19/2009
DEPARTMENT ACCOUNT P O NUMB INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 1013916794 865.34 OTHER EXPENSES T
,r
Order By Phone: -800- 356 -0783 Lab Safety Supply Inc.
Flirt
39- 18
7252 1.8
Order Online: www.I-SS.com GST# 89 172 6
D S M Order 13y Fax: 1- 800 543 -9910 401 S. Wright. Rd. PO Box 1368
Technical Support: 1 -800- 356 -2501 2� Janesville WI U.S.A. 53547 -1368
LAB SAFETY SUPPLY
PO Box 1368 I
Janesville, WI USA 53547-1368
002420 PAGE 1 OF 1
s CITY' OF CARMEL CITY OF CARMEL
ACCOUNTS PAYABLE 901 N RANGE LINE RD
-760 3RD AVE SW HOUSEHOLD HAZ WASTE
CARMEL IN 46032 -2072 :t CARMEL IN 46032 -1361
LA
SCO5344765 KELLAM08062009 5208827 1 1013916794 08/07/2009 09/06/2009
uy#t Carrtpr 1"ret rfn $3 ip Bate Paymefit ec!145
KELLAM,BILL UPS LOCKED 08/07/2009 Net 30
flTY Q Y IJ1111
:LINE ::..PRQlCT dES�tIE?T�11� &�J SHE.! IVI ..A }IT.. AMf�tT
1 135679 UTLTY CRT ECNMY 2 SHLF BL 31 0 2 EA 145.00 290.00
2 121949L GLV EXAM MICRO ONE LATEX LRG 0 10 BX 8.80 88.00
3 23727G UNVRSL SRBNT PD 16 WX18 L SP 0 1 PK 96.30 96.30
4 2153 -2 PH PPR JUM RFLL 0 -13 PH PHYD 0 10 EA 10.90 109.00
5 135753XL GLV EXAM POWERGRIP PWDR LATE 0 20 BX 9.80 196.00
SUBTOTAL: 779.30
Thank you for your order. FREIGHT: 86.04
TAXES: 0.00
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 09/06/2009 865.34 USD
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 TO 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.
C
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
179310
LAB SAFETY SUPPLY INC. Purchase Order No.
Acct 5208827 Terms
P.O. Box 5004 Due Date 8/14/2009
Janesville, WI 53547
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/14/2009 1013916794 $865.34
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
/�fZ'; A'
Date Officer
VOUCHER 096229 WARRANT ALLOWED
179310 IN SUM OF
LAB SAFETY SUPPLY INC.
Acct 5208827
P.O. Box 5004
Janesville, WI 53547
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1013916794 01- 720H -08 $865.34
l
Voucher Total $865.34
Cost distribution ledger classification if
claim paid under vehicle highway fund