208817 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC
CARMEL, INDIANA 46032 PO Box 4250
CHECK AMOUNT: $950.25
UTICA NY 13504
CHECK NUMBER: 208817
CHECK DATE: 5/1012012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 P3293026000 792.55 OTHER EXPENSES
601 5023990 P3298649010 157.70 OTHER EXPENSES
ORTHERN Remember... We Always Offer
Our Lowest Price When You Order. PLEASE REMIT To.
PO Box 4250 Utica, NY 13504 -4250 100% Satisfaction Guaranteed! NORTHERN SAFETY CO., INC.
Phone: 800. 631 1246 Fax: 800. 635. 1591 P.O. Box 4250
northernsafety.com Utica, NY 13504 -4250
SHIP TO (IF OTHER THAN "SOLD TO
YOUR CUSTOMER ID 'TIM UANDERGRIFF
PLEASE REFER TO ORDER 0003217619 CARMEL WATER DISTRIBUTION
3450 W 131ST ST
SOLD CARMEL, IN 46074 -8267
TO: CARMEL WATER DISTRIBUTION
3450 W 131ST ST
CARMEL, IN 46074
TIM -42512 04/25/12
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 05/25/12
INVOICE NO. /ORDER NO.
P329864901027 04125112 FEDEX GROUND 04/25/12 IF PAID BY 05/15/12 PAY $154.85
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
2 145 -31222 13 02 PR MEN STEEL TOE SNEAKER M WTH SZ 13 CH 64.95 129.90
12 12 126 -22067 L 01 PR NS PERFORMER RBR COATED STRING KNIT SZ L 1.04 12.48
1 SP2012CAT 01 EA 2012 CATALOG .00
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 172% PER SALES TAX SHIPPING HANDLING
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE
UNPAID BALANCE.
Payments must be payable in US dollars only
2% discount does not apply to credit card payments Thank You for Your Order!
FEDERAL ID# 16- 1214814
�N 0RTHER Remember... We Always Offer M
Our Lowest Price When You Order. PLEASE MM REMIT To.
PO Box 4250 Utica, NY 13504 -4250 1 00% Satisfaction Guaranteed NORTHERN SAFETY CO., INC.
Phone: 800. 631 1246 Fax: 800. 635. 1591 P.O. Box 4250
northernsafety, com
Utica, NY 13504 -4250
SHIP TO (IF OTHER THAN "SOLD TO
YOUR CUSTOMER ID F
C OMMUNICATIONS PLEASE REFER TO YOUR CUSTOMER ID, INVOICE AND
ORDER NO.* IN ALL 0003217619
TOL �CARMEL WATER DISTRIBUTION
3450 W 131ST ST
CARMEL, IN 46074 L
41812 04/18/12
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 05/24/12
INVOICE NO. /ORDER NO.
P329302600017 04/24/12 FEDEX GROUND 1 04/24/12 IF PAID BY 05/14/12 PAY $779.47
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
6 175 -27340 PR EA NS RIB MAT 4'X 6' PEPPER 46.08 276.48
5 E 175 -27336 PR EA NS RIB MAT 3'X 4' PEPPER FF 23.04 115.20
3 175 -27341 PR EA NS RIB MAT 4'X 8' PEPPER FF 61.44 184.32
5 265 -28337 01 BG RD SHOP TOWELS (50 /BG) NSTRSPB -50 15.60 78.00
i�
W
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. 138.5 .,...792...55
Payments must be payable in US dollars only
"2% discount does not apply to credit card payments Thank You for Your Order
FEDERAL ID# 1 6- 1 21 481 4
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
226500
NORTHERN SAFETY CO, INC Purchase Order No.
PO BOX 4250 Terms
UTICA, NY 13504 Due Date 5/1/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/1/2012 P3293026001 $792.55
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 p 5- 11- 10 -1.6
Date Officer
0
VOUCHER 114428 WARRANT ALLOWED
226500 IN SUM OF
NORTHERN SAFETY CO, INC
PO BOX 4250
UTICA, NY 13504
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
P3293026000 01- 6200 -06 $792.55
1ST-70
i
Voucher Total c
Cost distribution ledger classification if
claim paid under vehicle highway fund