211308 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
0 ONE CIVIC SQUARE HALSEN PRODUCTS
CARMEL, INDIANA 46032 PO BOX 877 CHECK AMOUNT: $322.20
BELMONT MS 38827
CHECK NUMBER: 211308
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4356001 0115661-IN 36 . 30 UNIFORMS
2201 4239012 0115707-IN 285 . 90 SAFETY SUPPLIES
INVOICE PAGE: 1
HALSEN PRODUCTS COMPANY
P.O.BOX 677
BELMONfT,MS 38827
NATIONWIDE 1-800.344-6696 INVOICE NUMBER:
FAX 1-800-826-8838 0115661-TN
INVOICE DATE: 7/18/2012
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
TOLD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ACCOUNTS PAYABLE DEPT BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
__CUSTOMER-,RO: __ _ —SHIP:VIA= -- _ xE9:g:�. r �- » , -:TERMS BONNIE UPS
Net 30
j dTEM NO._ UNIT _. ORDERED SHIPPED' BACK ORDER PRICE AMOUNT
AC3LY-X EACII 0 25 . 000 25.00
ANSI CLASS 3 SAFETY VE T L/Y
WITH VELCRO AND ZIPPER
Less Discount 0.00
THANK YO-U FOR YOUR ORDER ! ! Freight 11.30
Sales Tax 0 .00
Invoice Total 36 .30
_ ,.. - -
Less Deposit 0. 00
INVOICE BALANCE
HALSEN PRODUCTS COMPANY INVOICE PAGE-
P.O.BOX 877
BELMONT,MS 38827
NAFIONIMDE 1-800-3446596 INVOICE NUMBER:
FAX 1-800-826-8839 0115707-IN
INVOICE DATE: 7/20/2012
ORDER NUMBER:
ORDER DATE:
SALESPERSON: 0523
CUSTOMER NO: 0230327
30LD TO SHIP TO
CITY OF CARMEL STREET DEPARTMENT
ATTENTION ACCOUNTS PAYABLE BONNIE CALLAHAN
3400 W 131ST ST 3400 WEST 131 STREET
Westfield, IN 46074 Westfield, IN 46074
CONFIRM TO:
BONNIE
_I CUSTOMER'.P.O. –--- -•--SHIP'VIA` " . F.OB ,�_ _ __ . TERMS-
BONNIE UPS Net 30
ITEM NO.. .UNIT ORDERED SHIPPED BACK ORDER PRICE AMOUNT f
*
EACH 12 12 0 5 . 500 66. 00
ZONE II MATTE B K/ICE BLUE MIR
* EAC 12 12 0 5 .700 68 .40
ZONE II SILVER/ CE ORG MIRROR
*
EACF 12 12 0 4 .500 54 . 00
ZONE II MATTE B K/I/0 MIRROR
x
EACF 12 12 0 7 . 000 84 . 00
V2 METAL GUNMET L/I/O MIRROR
Ne -7 2-4.0.-
Less •Discount 0 . 00
THANK YOU FOR YOUR ORDER ! ! _ Freight 13 .50
Sales Tax 0 .00
Invoice Total 285 . 90
Less Deposit
285 gn
INVOICE BALANCE
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
07/18/12 0115661-IN $36.30
07/20/12 0115707-IN $285.90
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.
ALLOWED 20
Halsen Products
IN SUM OF $
P. O. Box 877
Belmont, MS 38827
$322.20
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
2201 0115661-IN 43-560.01 $36.30 1 hereby certify that the attached invoice(s), or
2201 0115707-IN 42-390.12 $285.90 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
f f
,-ThursdaysJyul:yZ26 72012
sOi 'Vn
L -IV V vt y —I v U
Sl a P`r^nmiccinnor
Street Commyssloner
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund