211400 07/31/2012 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: $109.97
UTICA NY 13504 CHECK NUMBER: 211400
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 900049481 109 . 97 OTHER EXPENSES
NORTHERN Remember...We Always Offer ® j'
Our Lowest Price When You Order. PLEASE REMIT To:
PO Box 4250 • Utica, NY 13504-4250 100%Satisfaction Guaranteed! MNORTHERN 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
• • • • • • Carmel Utilities
346023 3450 W 131 st St
CARMEL IN 46074-8267
SOLD USA
TO: Carmel Utilities
3450 W 131 st St L
CARMEL IN 46074-8267
USA
JACK 07/10/2012
YOUR PURCHASE ORDER NUMBER AND DATE
OUR INVOICE DATE SHIPPED VIA DATE SHIPPED
INVOICE NOJORDER NO. PAYMENT DUE BY 08/09/2012
900049481 /100029725 0711012012 FEDEX GROUND 07/10/2012 IF PAID BY 07/30/2012 PAY $ 108.02
ORDERED SHIPPED ITEM NO. UOM DESCRIPTION UNIT PRICE EXTENDED AMOUNT
2 2 4471 EA SPARKPLUGS PLUG STATION DISPEN 250 PR 40.33 80.66
1 1 30887 EA ACTIVGEL DISP KITS 23606 17.00 17.00
1 1 NC121 EA 2012 NEW CUSTOMER CATALOG KIT 0.00 0.00
�,
ACCOUNTS 30 DAYS AND OVER ARE SUBJECT TO A FINANCE CHARGE OF 11/2%PER SALES TAX SHIPPING&HANDLING o
MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%TO BE APPLIED TO THE
UNPAID BALANCE. $ 0.00 $ 12.31 $ 109.97
Pnvmentc mutt hP nnvnhlP in US dnllnrc nnly
VOUCHER # 121661 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
900049481 1( 01-6200-03 $109.97
Voucher Total $109.97
Cost distribution ledger classification if
claim paid under vehicle highway fund
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 7/24/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
7/24/2012 9000494811 $109.97
hereby certify that the attached invoice(s), or bill(s) is (are) true and
-orrect and I have audited same in accordance with IC 5-11-10-1.6
/30/1 L _c' Qom m
Date .`J°i 'r Ia Officer