168261 01/22/2009 CITY OF CARMEL, INDIANA VENDOR: 205250 Page 1 of 1
ONE CIVIC SQUARE MINE SAFETY APPLIANCES CO
CARMEL, INDIANA 46032 PO BOX 640348 CHECK AMOUNT: $1,148.57
PIMBURGH PA 15264 -0348 CHECK NUMBER: 168261
CHECK DATE: 1/22/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
11.10 X24239010 19005 94121011 1,148.57 RANGE SUPPLIES
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Mine Safety Appliances Company
PO Sox 426
Pittsburgh, PA 15230 -0426
D -U -N -S 00- 432 -1865
FEI 25- 0668780
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Invoice
Sold To: Invoice No.: 94121011
IJiiiiiiielilitieII,,,I,ILIiIJ Invoice Date: 12 Jan 2009
CARMEL POLICE DEPT Customer No.: 520000
3 CIVIC SQUARE Order No.: 3010090
CARMEL IN 46032 Delivery No.: 86069444
P.O. Date: 09 Jan 2009
Customer P.O. No.: 19005
Ship To:
C POLICE. DEPT
REF PO 19005
ATTN MAJOR JIM BARLOW
3 CIVIC SQUARE
CARMEL IN 46032
Your Contact Person: Customer Service
Telephone No.: 800 672 -2222 Fax No.: 800 -967 -0398 PAGE 1 1
Date Shipped Shipped via Bill of lading No. Terms of Shipment Terms of Payment
12 Jan 2009 UPS UNITED PARCEL SERVI FOB DEST /PPD /A NET 30 DAYS
Item Qty UM Mat No. Description Unit Price Net Price
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EFTA Batch Qty
10 6 EA 10079966 189.69 1,138.14
HEADSET, NECKBAND,BLACK CUP,SUPREME PRO
Shipping Info:
UPS UNITED PARCEL�,SERVI
UPS Ground
1ZI899350373456504
1Z1899350373456504
Remit Payment to: Ordered By: JIM BARLOW SubTotal: 1,138.14
Mine Safety Appliances Co. Telephone: 317- 571 -2527
P.O. Box 640348 Shipping Handling: 10.43
Pittsburgh, PA. 15264 -0348
Fax: 412- 967 -3087 Total USD: 1 ,148.57
THERE IS A SERVICE CHARGE OF
1.25% ON ALL ITEMS PAST DUE
THANK YOU FOR YOUR ORDER
0 f INDIANA RETAIL TAX EXEMPT PAGE
1
C T-, o .I, rmel CERTIFICATE NO. 003120155 002 0 1L ��i/ (SJS x PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 19005
30NECIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1.
December 17 2 08 range supplies
VENDOR Botach Tactical SHIP City of Carmel Police Department
3423 W. 43ddd Place TO 3 Civic Square
Los Agneles, CA 90008 Carmel, IN 46032
ATTN: Maovr Jim Marlow
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
6 10082166 MSA Sordin Supreme Pro -X Ear Muffs w /neckband 199.95 1,199.70
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4
City of Carmel Pot .e✓ R r 6� 1 t
Send Invoice To:
ATTN: Teresa Anderson
3 Ciut&cSquare
Carmel, IN $6032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 390 -10 ammo and accessories
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY /L!1/Y`C
SHIPPING LABELS. r
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
�jj 5 CLERK TREASURER
DOCUMENT CONTROL NO.
j O A.P. V. COPY SIGN AND RETURN TO CLERIC'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribe' 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Mine Safety Applicances Company Purchase Order No. 19005
P.O. Box 426 Terms
Pittsburgh, PA 15230 -0426 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/12/09 94121011 a ent for range supplies 1
Total
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Misie Safety Appliances Company IN SUM OF
P.O. Box 426
Pittsburgh, PA 15230 -0426
1
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
19005RF 94121011 390 -10 1,148.57 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
January 15 20 09
Signature
Chief of Pnlire
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund