209815 06/18/2012 F CITY OF CARMEL, INDIANA VENDOR: 226500 Page 1 of 1
ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $303.57
s CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 209815
CHECK DATE: 6/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4239012 303.57 I077758301013
O,RTHERN 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
PLEASE REFERJO YOUR CUSTOMER ID IKURTIS BAUMGARTNER
Y OUR ID O UR INVOICE AND
0004816021 CARMEL CLAY PARKS RECREATION
1235 CENTRAL PARK DRIVE EAST
TOLD CARMEL, IN 46032
CARMEL CLAY PARKS RECREATION
1411 E 116TH STt�
CARMEL, IN 46032 L
APR 3 0 2012 30697 04/25/12
L BY e YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA 1A1 DATE SHIPPED PAYMENT DUE BY 05/25/12
INVOICE NO. /ORDER NO.
I077758301013 04/25/12 FEDEX GROUND 04125112
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
10 1 250 -31964 01 BX NS STING RELIEF WIPES 10 /BX 2.00 20.00
10 1 249 -31039 01 BX BAND AID SHEER STRIPS ASSORTED PK /80 3.92 39.20
10 1 250 -30918 01 BX BZK ANTISEPTIC WIPES 100BX 1303 2.56 25.60
10 1 252 -4408 BE 01 EA EMT PARAMEDIC SCISSORS 5 .5" BE 3.99 39.90
10 1 249 -7243 01 BX STERILE PADS 4" X 4" 10BX 7226327 2.29 22.90
1 1 249 -5172 01 BX ELASTIKON ELAST TAPE 1''X2.5 YD 12 /RL BX 27.49 27.49
5 249 -5124 01 BX ZONAS POROUS TAPE 1'' X 10 YD 12 RL /BX 19.29 96.45
10 1 252 -1495 01 EA ELAST BANDAGES 2 "X 5 YARDS .92 9.20
Purchase WajLy rJ A+
Descr ption A
P.O. SQb9l P or®
G.L. 4
Budg t
Line escr
Purchaser Date
Apprc Val Date
s e
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 l/z 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
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.
226500 Northern Safety Co., Inc. Terms
P.O. Box 4250
Utica, NY 13504 -4250
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/25/12 1077758301013 Water Park first aid supplies 30697 303.57
Total 303.57
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
Voucher No. Warrant No.
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504 -4250
In Sum of
303.57
ON AI:GOuivT A FOR
109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1091 1077758301013 4239012 303.57 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
14 -Jun 2012
p mm-/
Signature
303.57 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund