210478 07/05/2012 R
VENDOR: 226500 puny
;�ITY,QF CARMEL, INDIANA
0 ONE CIVIC SQUARE NORTHERN SAFETY CO, INC CHECK AMOUNT: $688.89
CARMEL, INDIANA 46032 PO BOX 4250
UTICA NY 13504 CHECK NUMBER: 210478
CHECK DATE: 7/512012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1094 4239012 900004173 599.03 SAFETY SUPPLIES
1082 4239039 I07917630101 89.86 GENERAL PROGRAM SUPPL
®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
YOUR CUSTOMER ID KURTIS BAUMGARTNER
PLEASE REFER TO YOUR CUSTOMER; ID, OURINVOICE ANDY ,ORDER NO. IN ALL COMMUNICATIONS REGARDING THIS INV OICE
0004816021 CARMEL CLAY PARKS RECREATION
1235 CENTRAL PARK DRIVE EAST
SOLD F CARMEL, IN 46032
TO: CARMEL CLAY PARKS RECREATI CEIVED
1411 E 116TH ST L
CARMEL, IN 46032 JUN 0 4 2012
E0002584 05/30/12
YOUR PURCHASE ORDER NUMBER AND DATE
INVOICE O NO. INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 06
I079176301013 05/30/12 FEDEX GROUND 05/30/12
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
4 z 249 -1580 01 BX FABRIC STRIPS 3/4 X 3 100BX 1580033 4.27 17.08
2 2 250 -4350 01 BX TRIPLE ANTIBIOTIC OINTMENT 25 /BX 6.31 12.62
3 249 -7270 01 BX STERILE PADS 3"X 3" 100BX 7270033 11.16 33.48
1 1 250 -4645 01 BX HYDROCORTISONE CREAM 1% 25 /BX WJHYl -1800 4.97 4.97
2 252 -1724 01 BX COTTON TIPPED APPLICATOR STERILE 6'' 4.60 9.20
Purchase
Description
P.O. E 0CD( Z59 P or F
G.L. WU,- i- �23g o3a I �,.y
UnegDescr ��C� Yc�1 Y) SU LAS
Purchaser l� Date
Approval Date SALES TAX SHIPPING HANDLING
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 1 PER 12.51 89.86
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE
UNPAID BALANCE.
-.._A L_ -,_LI_
Ln3 �(f7J�Lrt� Ll 1 Remember.. We Always Offer F p
k 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 F Carmel Clay Parks Recreation
PLEASE REFER T O YOUR CUSTOMER OUR
OR69R NO IN COMMUNICATIONS 4816021 Eric
EID CARMEL IN 46033 1235 CENTRAL PARK DRIVE EAST
SOLD Carmel Clay Parks &Recreation I 9/
TO: 1411 E 116TH ST J 1 9 2012 USA
CARMEL IN 46032 L
USA
Dawn 06/06/2012
L YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED PAYMENT DUE BY 07/06/2012
INVOICE NOJORDER NO.
00004173 980001227 06/06/2012 FEDEX GROUND 06/06/2012 IF PAID BY 06/26/2012 PAY 588.02
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
NON- ADHERA STERILE PAD 3 "X 4 -100BX 10.85 217.00
25 25 2035 EA WATRPRF ADHES TAPE .5' X 5 YD 2035033 1.39 34.75
20 20 30963 BX ALCOHOL PREP PAD L 1 106 2.93 58.60
10 10 1728 EA HYDROGEN PEROXIDE 16 OZ BOT 1.39 13.90
10 10 8587 M BX FLEXSHIELD 5MIL POWD NITRILE GLV M PPNT 8.99 89.90
10 10 8587 L BX FLEXSHIELD 5MIL POWD NITRILE GLV SZ L 8.99 89.90
1 1 1305 CS SHEER STRIPS 3/4 X 3 1500CS 1304000 46.70 46.70
Purchase
Description d rr
P.O. i9 F
G.L. L IZ✓
Budget
Line Descr
Purchaser Date
Approval Date
SALES TAX SHIPPING HANDLING R e
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF Ph% PER
-MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18% TO BE APPLIED TO THE -O.00 48.28 599.03
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
5/30112 1079176301013 Supplies 89
6/6/12 900004173 Water Park first aid supplies 30927 599.03--
Total 688.89
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.
I
226500 Northern Safety Co., Inc. Allowed 20
P.O. Box 4250
Utica, NY 13504 -4250
In Sum of
688.89
ON ACCOUNT OF APPROPRIATION FOR
108 ESE 109 Monon Center
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
1082 -1 1079176301013 4239039 89.86 1 hereby certify that the attached invoice(s), or
1094 900004173 4239012 599.03 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
28 -Jun 2012
Signature
688.89 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
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