173531 06/10/2009 =�F CITY OF CARMEL, INDIANA VENDOR: 276575 Page 1 of 1
0 ONE CIVIC SQUARE SAFETY SOLUTIONS, INC CHECK AMOUNT: $140.00
r CARMEL, INDIANA 46032 PO Box 8100
o DUBLIN OH 46016 -2100 CHECK NUMBER: 173531
CHECK DATE: 6/1012009
DE PARTME NT A CCOUNT PO NUMBER INV NUMBER v AMOUNT DESCRIPTION
601 5023990 01506768 140.00 OTHER EXPENSES
I A rr�`y A ni LTI� r_ 6161 Shamrock CI P.O. Box 8100
f o�m�,off4sals -zloo Inv01Ce 01506768
I N C O R P O R A T E D III L-1 800 232.7463 (fax)614 799.9901
Regional Offices 8 Distribution Centers Pag 1
Birmingham, AL Mobile, AL Columbus, OH Toledo, OH
866.247.9399 888.871.7463 800.232.7463 419.380.9900 o. Date 05
Pittsburgh, PA Syracuse, NY Auburn, IN
800.562 0555 800.8367463 260.927.1956 m
Due Date 05/30/2009
Sold To, _;:129700 Ship To: 129700
City Of Carmel City Of Carmel
Water Distribution Water Distribution
3450 W 131 st ST 3450 W 131st ST
Westfield, IN 46074 Westfield, IN 46074
wr
Customer °Pp, Number Releisse No Salesperson Whse Sflp Date' Document
Brian °1 Dian iase E3arzak 01 05/1 F /2009 01413408
Perms Tax Code' Freight Ship °Ula
Net 15 IN15 Prepaid Fedex Ground Intl Economy
ktem Number Descnption f l Ordered Shipped Backorder UM" 1?rlce Per lwxtensiori
akra "r. 1 Sf�yl
0100000380591130 1 1 0 PR 140.00 PR 140.00
3805 WOLVERINE BOOT 13EW
Tolan, Brian
Shipping warehouse: 58
7
i
!?emit TO: Safety OIUtIOnS� In O Due e a Payments Ttdl
y p MerCh
PO Box 8100 nd�eS &H r Tax
a s
Dublin, OH 43016 -2100 140.00 0.00 0.00 140.00
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
z
276575
SAFETY SOLUTIONS Purchase Order No.
6161 Shamrock Ct. Terms
P.O. Box 8100 Due Date 5/28/2009
Dublin, OH 43016
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/28/2009 01506768 $140.00
I 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
Z 1-51 f
Date Officer
VOUCHER 091953 WARRANT ALLOWED
276575 �A IN SUM OF
SAFETY SOLUTIONS Ln
6161 Shamrock Ct.���f\
P.O. Box 8100 R N
Dublin, OH 4
Carmel. Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
01506768 01- 6200 -04 $140.00
Voucher Total $140.00
Cost distribution ledger classification if
claim paid under vehicle highway fund