211767 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00351010 Page 1 of 1
ONE CIVIC SQUARE HALSEN PRODUCTS
0 CHECK AMOUNT: $4,195.75
CARMEL, INDIANA 46032 PO BOX 877
BELMONT MS 38827 CHECK NUMBER: 211767
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239011 0115755-IN 926 . 28 SPECIAL DEPT SUPPLIES
2201 4356001 0115823-IN 3 , 269. 47 UNIFORMS
HALSEN PRODUCTS COMPANY
INVOKE PAGE: 1
P.O.BOX BT/
BELMON T,,MS 38827
NATIONMDE I-s0G,344-6696 INVOICE NUMBER: 0115823-IN
FAX 1-800$26-8639 INVOICE DATE: 7/31/2012
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
p�Westfield, IN 46074 Westfield, IN 46074
C BONNI�'
= — - .-�= __ �- -c- �� —
CUSTOMER.P.O: r-.-. SHIP`VIA - `F.uB• TERMS: .,
BONNIE UPS
Net 30
ITEM NO. UNIT ORDERED SHIPPED BACKORDER PRICE AMOUNT f
AC3BZLY-M EACI 25 25 0 20. 000 500 . 00
CLASS 3 MESH VEST LIME YELLOW
AC3BZLY-L EACf 25 25 0 20. 000 500. 00
CLASS 3 MESH VEST LIME YELLOW
AC3BZLY-X EACf 50 50 0 20. 000 1000. 00
CLASS 3 MESH VEST LIME YELLOW
AC3BZLY-XX EACf 50 50 0 20 .500 1025 . 00
CLASS 3 MESH VEST LIME YELLOW
AC3BZLY-XXX EACI 5 5 0 20.500 102 .50
CLASS 3 MESH VEST LIME YELLOW
AC3BZLY-4X EACI 5 5 0 21. 000 105 .00
CLASS 3 MESH VEST LIME YELLOW
Net Invoice 3232 . 50
Less Discount 0 .00
THANK YOU FOR YOUR ORDER ! ! Freight 36. 97
Sales .Tax 0 .00
Invoice Total- 3269.47
Less Deposit 0. 00
3269.47
INVOICE BALANCE
1
HALSEN PRODUCTS COMPANY INVOICE PAGE:
P.O.BOX 877
BELMONT,MS 38827
NATIONWIDE 1-80U-344-66% INVOICE NUMBER: 0115755-IN
FAX 1-800-826-8839 INVOICE DATE: 7/27/2012
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
C%F�YV 10:
_ -.
CUSTOMERPO.. ., SHIP VIA F.DB;— — _T , _ - -- --TERMS =,--
BONNIE UPS
Net 30
ITEM NO. UNIT :ORDERED SHIPPED' BACK ORDER PRICE AMOUNT 1
19951 EACH 12 12 0 14 .250 171. 00
HARD HAT WHITE RATCH OMEGA II
19953 EACH 50 50 0 14 .250 712 .50.
HARD HAT OMEGA I RATC ET ORAN
Net Invoice: 883 . 50
Less Discount: 0. 00
THANK YOU FOR YOUR ORDER ! ! Freight: 42 .78
Sales Tax: 0 .00
__..Invoi,ce-.Total-: 926.28
Less Deposit: 0 .00
926.28
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))
07/27/12 0115755-IN $926.28
07/31/12 0115823-in $3,269.47
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
$4,195.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE I AMOUNT Board Members
2201 0115755-IN j 42-390.11 j $926.28 1 hereby certify that the attached invoice(s), or
2201 0115823-in 43-560.01 $3,269.47 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
Th i tsday; u�gust 09, 2012
Street Commissioner
�PrFPt C:'�mmi�cnrr�.
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund